Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Cancer Cytopathol. 2018 Jun;126(6):414-420. doi: 10.1002/cncy.21988. Epub 2018 Apr 16.
Making a specific diagnosis of pancreatic cysts preoperatively is difficult. The new disposable Moray micro forceps biopsy (MFB) device allows tissue sampling from the pancreatic cyst wall/septum and aims to improve diagnosis. This study compares the diagnostic performance of the MFB with the current conventional analysis of pancreatic cyst fluid (PCF).
A total of 48 patients sampled with MFB were identified. Cysts were classified as mucinous on PCF based on extracellular mucin/mucinous epithelium, carcinoembryonic antigen (CEA) levels ≥192 ng/mL, or KRAS/GNAS mutation. A diagnosis of intraductal papillary mucinous neoplasm was supported by GNAS mutation; a diagnosis of serous cystadenoma was supported by Von Hippel-Lindau tumor suppressor (VHL) mutation. A diagnosis of mucinous cystic neoplasm required the presence of subepithelial ovarian-type stroma. A high-risk cyst was defined as a mucinous cyst with high-grade dysplasia or an adenocarcinoma. Comparisons in diagnostic performance between PCF and MFB were made.
The mean age of the patients was 69.6 years (range, 27-90 years); 25 of 48 patients (52.1%) were female. Cysts were in the pancreatic head (13 patients), neck (2 patients), body (20 patients), and tail (13 patients), averaging 3.1 cm (range, 1.2-6.0 cm). There was concordance with mucinous versus nonmucinous classification (60.4% for PCF vs 58.3% for MFB; P = .949). Three high-risk cysts were detected by PCF and 2 were detected by MFB (P = .670). However, MFB diagnosed significantly more specific cysts compared with PCF (50.0% for MFB vs 18.8% for PCF; P<.001).
PCF analysis and MFB have comparable performance in distinguishing between mucinous and nonmucinous cysts and for detecting high-risk cysts. However, MFB was found to be superior for diagnosing specific cyst subtypes, thus adding significant value to preoperative patient management. Cancer Cytopathol 2018;126:414-20. © 2018 American Cancer Society.
术前对胰腺囊肿进行明确诊断较为困难。新型一次性莫雷（Moray）微夹活检（MFB）装置可对胰腺囊肿壁/间隔进行组织取样，旨在提高诊断水平。本研究比较了 MFB 与当前常规胰腺囊液（PCF）分析的诊断性能。
共发现 48 例接受 MFB 取样的患者。根据细胞外黏蛋白/黏液上皮、癌胚抗原（CEA）水平≥192ng/mL 或 KRAS/ GNAS 突变，将囊液分类为黏液性。存在 GNAS 突变支持导管内乳头状黏液性肿瘤的诊断；存在 Von Hippel-Lindau 肿瘤抑制因子（VHL）突变支持浆液性囊腺瘤的诊断。存在上皮下卵巢样基质支持黏液性囊腺瘤的诊断。高危囊肿定义为具有高级别异型增生或腺癌的黏液性囊肿。比较了 PCF 和 MFB 在诊断性能方面的差异。
患者的平均年龄为 69.6 岁（范围，27-90 岁）；25 例（52.1%）为女性。囊肿位于胰头部（13 例）、颈部（2 例）、体部（20 例）和尾部（13 例），平均直径为 3.1cm（范围，1.2-6.0cm）。PCF 与非黏液性分类的一致性为 60.4%，MFB 为 58.3%（P=.949）。PCF 检测到 3 例高危囊肿，MFB 检测到 2 例（P=.670）。然而，MFB 诊断出的特异性囊肿明显多于 PCF（MFB 为 50.0%，PCF 为 18.8%；P<.001）。
PCF 分析和 MFB 在区分黏液性和非黏液性囊肿以及检测高危囊肿方面具有相似的性能。然而，MFB 对诊断特定囊肿类型具有优势，因此为术前患者管理提供了重要价值。癌症细胞病理学 2018；126:414-20。©2018 美国癌症协会。
