Chen Longwen, Nassar Aziza, Kommineni Vishnu Teja, Zarka Matthew A, Zhang Jun, Faigel Douglas, Nguyen Cuong, Halfdanarson Thorvardur R, Pannala Rahul
Department of Laboratory Medicine and Pathology, Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, Arizona.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida.
J Am Soc Cytopathol. 2015 Nov-Dec;4(6):335-343. doi: 10.1016/j.jasc.2015.04.001. Epub 2015 Apr 15.
Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) cytology is widely used to evaluate solid and cystic pancreatic lesions preoperatively. Pancreatic neuroendocrine tumors (PanNETs) are typically solid, but when they are cystic, differentiation from other pancreatic cystic neoplasms can be challenging. We examined cases of cystic PanNETs (cPanNETs) from 3 Mayo Clinic Hospitals focusing on the EUS-FNA cytology.
A total of 21 EUS-FNA cases of cPanNETs with histology confirmation were identified from the Mayo Clinic Health System database. The patients' demographic data, clinical, radiological, and EUS characteristics were obtained. EUS-FNA cytology and surgical pathology were reviewed.
Among the 21 patients with cPanNETs, only 2 of 21 cases had suggestion of cPanNET on preoperative imaging (computed tomography/magnetic resonance imaging). On EUS, most cPanNETs (16/ of 21) had ≥1 high-risk stigmata or worrisome feature per the Sendai Consensus guidelines. None of the cases had an elevated carcinoembryonic antigen level. EUS-FNA cytology was positive or suspicious for cPanNET in 15 of 21 cases (71.4%). Immunohistochemical stains of neuroendocrine markers were performed on all the positive or suspicious cases and showed positivity for ≥1 neuroendocrine marker. All cases had surgical resection and the diagnosis of cPanNET was confirmed on each case.
Although computed tomography/magnetic resonance imaging has a low specificity for detecting cPanNETs, high-risk features on EUS and low carcinoembryonic antigen levels should raise the suspicion for cPanNET. EUS-FNA cytology along with immunohistochemical stains has a high accuracy in establishing the preoperative diagnosis of cPanNET.
内镜超声引导下细针穿刺抽吸（EUS-FNA）细胞学检查被广泛用于术前评估胰腺实性和囊性病变。胰腺神经内分泌肿瘤（PanNETs）通常为实性，但当它们为囊性时，与其他胰腺囊性肿瘤进行鉴别可能具有挑战性。我们研究了来自梅奥诊所3家医院的囊性PanNETs（cPanNETs）病例，重点关注EUS-FNA细胞学检查。
从梅奥诊所医疗系统数据库中识别出21例经组织学证实的cPanNETs的EUS-FNA病例。获取了患者的人口统计学数据、临床、放射学和EUS特征。回顾了EUS-FNA细胞学检查和手术病理结果。
在21例cPanNETs患者中，术前影像学检查（计算机断层扫描/磁共振成像）仅2例提示为cPanNET。在EUS检查中，根据仙台共识指南，大多数cPanNETs（21例中的16例）具有≥1个高风险特征或令人担忧的特征。所有病例的癌胚抗原水平均未升高。21例中有15例（71.4%）的EUS-FNA细胞学检查对cPanNET呈阳性或可疑。对所有阳性或可疑病例进行了神经内分泌标志物的免疫组织化学染色，结果显示≥1种神经内分泌标志物呈阳性。所有病例均接受了手术切除，每例均确诊为cPanNET。
尽管计算机断层扫描/磁共振成像检测cPanNETs的特异性较低，但EUS上的高风险特征和低癌胚抗原水平应引起对cPanNET的怀疑。EUS-FNA细胞学检查联合免疫组织化学染色在术前诊断cPanNET方面具有很高的准确性。
