Endoscopic ultrasonography-guided fine-needle aspiration cytology of surgically confirmed cystic pancreatic neuroendocrine tumors

A Mayo Clinic experience

Longwen Chen, Aziza Nassar, Vishnu Teja Kommineni, Matthew A. Zarka, Jun Zhang, Douglas Orrick Faigel, Cuong C Nguyen, Thorvardur R. Halfdanarson, Rahul Pannala

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: 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. Materials and methods: 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. Results: Among the 21 patients with cPanNETs, only 2 of 21 cases had suggestion of cPanNET on preoperativeimaging (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. Conclusions: 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.

Original languageEnglish (US)
JournalJournal of the American Society of Cytopathology
DOIs
StateAccepted/In press - Feb 9 2015

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Endosonography
Neuroendocrine Tumors
Fine Needle Biopsy
Cell Biology
Carcinoembryonic Antigen
Coloring Agents
Tomography
Magnetic Resonance Imaging
Christianity
Surgical Pathology
Pancreatic Neoplasms
Histology
Demography
Databases
Guidelines
Health

Keywords

  • Cystic pancreatic neuroendocrine tumor
  • Endoscopic ultrasonography-guided fine-needle aspiration cytology
  • Pancreatic cyst
  • Preoperative diagnosis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Endoscopic ultrasonography-guided fine-needle aspiration cytology of surgically confirmed cystic pancreatic neuroendocrine tumors : A Mayo Clinic experience. / Chen, Longwen; Nassar, Aziza; Kommineni, Vishnu Teja; Zarka, Matthew A.; Zhang, Jun; Faigel, Douglas Orrick; Nguyen, Cuong C; Halfdanarson, Thorvardur R.; Pannala, Rahul.

In: Journal of the American Society of Cytopathology, 09.02.2015.

Research output: Contribution to journalArticle

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title = "Endoscopic ultrasonography-guided fine-needle aspiration cytology of surgically confirmed cystic pancreatic neuroendocrine tumors: A Mayo Clinic experience",
abstract = "Introduction: 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. Materials and methods: 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. Results: Among the 21 patients with cPanNETs, only 2 of 21 cases had suggestion of cPanNET on preoperativeimaging (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. Conclusions: 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.",
keywords = "Cystic pancreatic neuroendocrine tumor, Endoscopic ultrasonography-guided fine-needle aspiration cytology, Pancreatic cyst, Preoperative diagnosis",
author = "Longwen Chen and Aziza Nassar and Kommineni, {Vishnu Teja} and Zarka, {Matthew A.} and Jun Zhang and Faigel, {Douglas Orrick} and Nguyen, {Cuong C} and Halfdanarson, {Thorvardur R.} and Rahul Pannala",
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T1 - Endoscopic ultrasonography-guided fine-needle aspiration cytology of surgically confirmed cystic pancreatic neuroendocrine tumors

T2 - A Mayo Clinic experience

AU - Chen, Longwen

AU - Nassar, Aziza

AU - Kommineni, Vishnu Teja

AU - Zarka, Matthew A.

AU - Zhang, Jun

AU - Faigel, Douglas Orrick

AU - Nguyen, Cuong C

AU - Halfdanarson, Thorvardur R.

AU - Pannala, Rahul

PY - 2015/2/9

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N2 - Introduction: 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. Materials and methods: 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. Results: Among the 21 patients with cPanNETs, only 2 of 21 cases had suggestion of cPanNET on preoperativeimaging (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. Conclusions: 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.

AB - Introduction: 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. Materials and methods: 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. Results: Among the 21 patients with cPanNETs, only 2 of 21 cases had suggestion of cPanNET on preoperativeimaging (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. Conclusions: 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.

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KW - Preoperative diagnosis

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