Bernstein Jane, Ustun Berrin, Alomari Ahmed, Bao Fang, Aslanian Harry R, Siddiqui Uzma, Chhieng David, Cai Guoping
Department of Pathology and Internal Medicine, Yale University, School of Medicine, New Haven, Connecticut, USA.
Cytojournal. 2013 May 29;10:10. doi: 10.4103/1742-6413.112648. Print 2013.
Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas, which are increasingly diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this retrospective study, we assessed the performance of EUS-FNA in diagnosing PNETs.
We identified 48 cases of surgically resected PNETs in which pre-operative EUS-FNA was performed. The clinical features, cytological diagnoses, and surgical follow-up were retrospectively reviewed. The diagnostic performance of EUS-FNA was analyzed as compared to the diagnosis in the follow-up. The cases with discrepancies between cytological diagnosis and surgical follow-up were analyzed and diagnostic pitfalls in discrepant cases were discussed.
The patients were 20 male and 28 female with ages ranging from 15 years to 81 years (mean 57 years). The tumors were solid and cystic in 41 and 7 cases, respectively, with sizes ranging from 0.5 cm to 11 cm (mean 2.7 cm). Based on cytomorphologic features and adjunct immunocytochemistry results, when performed, 38 patients (79%) were diagnosed with PNET, while a diagnosis of suspicious for PNET or a diagnosis of neoplasm with differential diagnosis including PNET was rendered in the 3 patients (6%). One case was diagnosed as mucinous cystic neoplasm (2%). The remaining 6 patients (13%) had non-diagnostic, negative or atypical diagnosis.
Our data demonstrated that EUS-FNA has a relatively high sensitivity for diagnosing PNETs. Lack of additional materials for immunocytochemical studies could lead to a less definite diagnosis. Non-diagnostic or false negative FNA diagnosis can be seen in a limited number of cases, especially in those small sized tumors.
胰腺神经内分泌肿瘤（PNETs）是胰腺的罕见肿瘤，越来越多地通过内镜超声引导下细针穿刺抽吸术（EUS-FNA）进行诊断。在这项回顾性研究中，我们评估了EUS-FNA在诊断PNETs中的表现。
我们确定了48例接受手术切除的PNETs病例，这些病例术前均进行了EUS-FNA。对其临床特征、细胞学诊断和手术随访进行了回顾性分析。将EUS-FNA的诊断性能与随访诊断进行比较分析。对细胞学诊断与手术随访结果存在差异的病例进行分析，并讨论差异病例中的诊断陷阱。
患者中男性20例，女性28例，年龄范围为15岁至81岁（平均57岁）。肿瘤分别为实性和囊性的有41例和7例，大小范围为0.5 cm至11 cm（平均2.7 cm）。根据细胞形态学特征和辅助免疫细胞化学结果（如有），38例患者（79%）被诊断为PNET，3例患者（6%）被诊断为疑似PNET或诊断为包括PNET在内的鉴别诊断的肿瘤。1例被诊断为黏液性囊性肿瘤（2%）。其余6例患者（13%）诊断不明确、为阴性或非典型诊断。
我们的数据表明，EUS-FNA对诊断PNETs具有相对较高的敏感性。缺乏用于免疫细胞化学研究的额外材料可能导致诊断不太明确。在少数病例中可见非诊断性或假阴性FNA诊断，尤其是在那些小尺寸肿瘤中。
