Centeno B A, Warshaw A L, Mayo-Smith W, Southern J F, Lewandrowski K
Department of Pathology, Massachusetts General Hospital, Boston 02114, USA.
Acta Cytol. 1997 Jul-Aug;41(4):972-80. doi: 10.1159/000332775.
To prospectively evaluate fine needle aspiration biopsy (FNAB) of pancreatic cystic lesions.
We performed a blind, prospective study on percutaneous aspirates from 28 radiographically identified cysts, including 6 inflammatory cysts (5 pseudocysts and 1 abscess), 4 serous cystadenomas, 1 cystic islet cell tumor, 5 mucinous cystic neoplasms, 6 mucinous cystadenocarcinomas and 6 nonpancreatic cysts.
Four of six (67%) cystadenocarcinomas were identified as malignant, and the other two, which lacked sufficient morphologic criteria for malignancy, as consistent with mucinous cystic neoplasm. Two of five mucinous cystic neoplasms were correctly classified. One, which contained atypical cells, did not appear to be mucinous on the ThinPrep, and one, which lacked an epithelial component, was suggested because of the presence of mucin in the background. The fifth one contained inflammatory cells only. One of four serous cystadenomas produced a diagnostic specimen. FNAB of the cystic islet cell tumor was nondiagnostic. Five of six inflammatory cysts (83%) were correctly diagnosed, whereas one case produced an acellular, nondiagnostic specimen. Six of 28 (23%) cases were nonpancreatic cysts, aspirated under the presumption that they were pancreatic cysts based on radiologic studies: only one case, a papillary cystadenocarcinoma of the stomach, was correctly diagnosed; the other five cases were nondiagnostic, and in two of these the assumption that the cysts were pancreatic in origin precluded an accurate classification.
FNAB of pancreatic cystic lesions can differentiate mucinous from nonmucinous pancreatic cysts and provide definitive evidence of malignancy. In some cases, serous cystadenomas can be diagnosed. Pseudocysts can be suspected on the basis of an inflammatory smear lacking both epithelial cells and background mucin, but this finding is not specific. Nonpancreatic lesions constitute a significant percentage of cases aspirated as pancreatic cysts and present a major pitfall in cytologic interpretation.
前瞻性评估胰腺囊性病变的细针穿刺活检（FNAB）。
我们对28例经影像学检查发现的囊肿进行了盲法前瞻性经皮抽吸研究，其中包括6例炎性囊肿（5例假性囊肿和1例脓肿）、4例浆液性囊腺瘤、1例囊性胰岛细胞瘤、5例黏液性囊性肿瘤、6例黏液性囊腺癌和6例非胰腺囊肿。
6例囊腺癌中有4例（67%）被诊断为恶性，另外2例因缺乏足够的恶性形态学标准，被诊断为符合黏液性囊性肿瘤。5例黏液性囊性肿瘤中有2例被正确分类。1例含有非典型细胞，在ThinPrep涂片上似乎不是黏液性的，1例缺乏上皮成分，因背景中有黏液而被提示。第5例仅含有炎性细胞。4例浆液性囊腺瘤中有1例获得了诊断性标本。囊性胰岛细胞瘤的FNAB未得出诊断结果。6例炎性囊肿中有5例（83%）被正确诊断，而1例产生了无细胞的非诊断性标本。28例中有6例（23%）为非胰腺囊肿，根据影像学研究推测为胰腺囊肿而进行了抽吸：仅1例胃乳头状囊腺癌被正确诊断；其他5例为非诊断性，其中2例因认为囊肿起源于胰腺而无法进行准确分类。
胰腺囊性病变的FNAB可区分黏液性和非黏液性胰腺囊肿，并提供恶性的确定性证据。在某些情况下，可诊断浆液性囊腺瘤。假性囊肿可根据缺乏上皮细胞和背景黏液的炎性涂片怀疑，但这一发现并不特异。非胰腺病变在作为胰腺囊肿抽吸的病例中占相当比例，是细胞学解释中的一个主要陷阱。
