Fine Needle Aspiration Cytology from Pancreatic Cysts- Limited Utility in Surgical Decision Making
Craig P. Fischer*1,2, Bridget N. Fahy1,2, Thomas a. Aloia1,2, Isaac Raijman1, Alberto O. Barroso1,2, Peter J. Schwarz1,2, Barbara L. Bass1,2
1Surgery, The Methodist Hospital, Houston, TX; 2Surgery, Weill Cornell Medical College, Houston, TX
INTRODUCTION. Endoscopic Ultrasound (EUS) plays an important role in the diagnosis of cystic and solid pancreatic lesions. Fine needle aspiration cytology(FNAC) aids physicians in determining which patients require surgical resection. We report the utility of EUS/FNAC in the diagnosis of cystic and solid pancreatic lesions.METHODS. Fifty-eight patients underwent EUS/FNAC of pancreatic lesions between 7/2006- 7/2008. Fifty-two patients had evaluable cytology, and 33 patients underwent surgical resection. FNAC results were categorized into suspicious/positive for malignancy, negative and indeterminate, based on routine hematoxylin and eosin staining performed by a single cytopathologist. The sensitivity (S), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of FNAC were determined based upon comparison to final surgical pathology. RESULTS. Of the 33 total pancreatic lesions reviewed, 17 were solid and 16 were cystic. Twenty-four total lesions (12 solid, 12 cystic) were malignant or premalignant (73%). FNAC of solid lesions had a S of 100%, SP of 80% PPV of 92% and NPV of 100%. FNAC for cystic lesions had a S of 58%, SP of 100%, PPV of 100%, and NPV of 44% (Table). While none of the malignant solid lesions had negative FNAC, 5/12 (42%) of malignant or premalignant cystic lesions were negative for malignancy on FNAC.CONCLUSIONS. FNAC demonstrated excellent accuracy in the diagnosis of solid pancreatic lesions. FNAC of cystic pancreatic lesions was appreciably less accurate and alone does not appear to be an adequate means of assessing the malignant potential of cystic pancreatic lesions.
EUS-FNA Cytology (no. of patients)
| SURGICAL PATHOLOGY | INDETERMINATE | SUSPICIOUS OR POSITIVE FOR MALIGNANCY | NEGATIVE | TOTAL | SENSITIVITY | SPECIFICITY | POSITIVE PREDICTIVE VALUE | NEGATIVE PREDICTIVE VALUE |
| SOLID LESIONS | - | - | - | 17 | 1.00 | 0.800 | 0.92 | 1.00 |
| Pancreatic Carcinoma | 2 | 7 | 0 | 9 | - | - | - | - |
| Neuroendocrine | 1 | 1 | 0 | 2 | - | - | - | - |
| Metastatic to Pancreas | 0 | 1 | 0 | 1 | - | - | - | - |
| Benign | 1 | 0 | 4 | 5 | - | - | - | - |
| CYSTIC LESIONS | - | - | - | 16 | 0.58 | 1.00 | 1.00 | 0.44 |
| Mucinous Cystadenoma (MCN) | 1 | 2 | 3 | 6 | - | - | - | - |
| IPMN | 1 | 1 | 2 | 4 | - | - | - | - |
| MCN or IPMN with Carcinoma | 1 | 1 | 0 | 2 | - | - | - | - |
| Serous Cystadenoma | 0 | 0 | 2 | 2 | - | - | - | - |
| Pseudocyst | 0 | 0 | 2 | 2 | - | - | - | - |
| Total | 7 | 13 | 13 | 33 | - | - | - | - |
MCN - mucinous cystic neoplasia IPMN - intraductal papillary mucinous neoplasm
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