Department of Pathology, Division of Anatomic Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Cytopathol. 2014 Jun;122(6):428-34. doi: 10.1002/cncy.21389. Epub 2014 Jan 16.
The objective of this study was to assess how atypical diagnostic category (ADC) is followed up, its outcomes, and the predictors that are associated with subsequent diagnosis of neoplasm/malignancy.
We reviewed pancreatic endoscopic ultrasound fine-needle aspiration (EUS-FNA) with ADC and compared the rate of detection of neoplasms after a repeat FNA, a biopsy/resection, or a clinical follow-up following ADC. Logistic regression was used to determine the factors associated with the diagnosis of a neoplastic or a malignant lesion following ADC. Predictive probability for each case was calculated on the basis of the significant predictors, and whether it improved diagnostic performance was assessed.
Of 3832 cases that received pancreatic EUS-FNAs, 187 (4.9%) were ADC. A total of 93 neoplasms (55%), including 61 carcinomas (36%), were detected after an atypical cytologic diagnosis. Similar rates of detecting neoplasms were observed after repeat FNA or biopsy/resection but higher than after clinical follow-up. The presence of a mass, history of alcohol use, and absence of a history of pancreatitis were significant predictors of a higher rate of diagnosis of neoplasm. Weight loss and bile flow obstruction were more likely to be associated with higher rates of carcinoma. Predictive probability demonstrated a wide range of risk and changed the ambiguous diagnosis to informative in 30% of cases.
ADC of pancreas is associated with a high risk of benign and malignant neoplasms regardless of the method of follow-up. The presences of a mass, alcohol use, and absence of a history of pancreatitis are significant predictors of a diagnosis of neoplasm, whereas weight loss and bile duct obstruction are significant predictors of ductal carcinoma following an ADC.
本研究旨在评估不典型诊断类别（ADC）的随访情况、结局，以及与随后诊断为肿瘤/恶性肿瘤相关的预测因素。
我们回顾性分析了胰腺内镜超声引导下细针抽吸活检（EUS-FNA）中出现 ADC 的病例，并比较了在 ADC 后再次进行 FNA、活检/切除或临床随访时发现肿瘤的比例。采用 logistic 回归分析确定 ADC 后诊断为肿瘤或恶性病变的相关因素。基于有统计学意义的预测因素计算每个病例的预测概率，并评估其是否改善了诊断性能。
在 3832 例行胰腺 EUS-FNA 的患者中，187 例（4.9%）为 ADC。在不典型细胞学诊断后，共发现 93 个肿瘤（55%），包括 61 个癌（36%）。在重复 FNA 或活检/切除后，发现肿瘤的比例相似，但高于临床随访后。存在肿块、饮酒史和无胰腺炎史是肿瘤诊断率较高的显著预测因素。体重减轻和胆汁淤积更可能与更高的癌发生率相关。预测概率显示出广泛的风险范围，并使 30%的不确定诊断变为有信息性的诊断。
胰腺 ADC 无论随访方式如何，均与良性和恶性肿瘤的高风险相关。存在肿块、饮酒史和无胰腺炎史是肿瘤诊断的显著预测因素，而体重减轻和胆管阻塞是 ADC 后导管癌的显著预测因素。
