Optimizing the multimodal approach to pancreatic cyst fluid diagnosis 1. Issue 2 (7th September 2012)

• Record Type: Journal Article
• Authors: Chai, Siaw Ming; Herba, Karl; Kumarasinghe, M. Priyanthi; de Boer, W. Bastiaan; Amanuel, Benhur; Grieu‐Iacopetta, Fabienne; Lim, Ee Mun; Segarajasingam, Dev; Yusoff, Ian; Choo, Chris; Frost, Felicity
• Is Part Of: Cancer cytopathology. Volume 121:Issue 2(2013:Feb.)
• Page Start: 86
• Page End: 100
• Publication Date: 2012-09-07
• Subjects: Cancer -- Cytopathology -- Periodicals; Pathology, Cellular -- Periodicals; Cytology -- Technique -- Periodicals; 611.01815
• DOI: 10.1002/cncy.21226
• Languages: English
• ISSNs: 1934-662X

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>BACKGROUND</title> <p>The objective of this study was to develop a triage algorithm to optimize diagnostic yield from cytology, carcinoembryonic antigen (CEA), and v‐Ki‐<italic>ras</italic>2 Kirsten rat sarcoma viral oncogene homolog (<italic>KRAS</italic>) testing on different components of a single pancreatic cyst fluid specimen. The authors also sought to determine whether cell block supernatant was suitable for CEA and <italic>KRAS</italic> testing.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>METHODS</title> <p>Fifty‐four pancreatic cysts were triaged according to a volume‐dependent protocol to generate fluid (neat and supernatant) and cell block specimens for cytology, comparative CEA, and <italic>KRAS</italic> testing. Follow‐up histology, diagnostic cytology, or a combined clinicopathologic interpretation was recorded as the final diagnosis.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>RESULTS</title> <p>There were 26 mucinous cystic lesions and 28 nonmucinous cystic lesions with volumes ranging from 0.3 mL to 55 mL. Testing different components of the specimens (cell block, neat, and/or supernatant) enabled all laboratory investigations to be performed on 50 of 54 cyst fluids (92.6%). Interpretive concordance was observed in 17 of 17 cases (100%) and in 35 of 40 cases (87.5%) that had multiple components tested for CEA and <italic>KRAS</italic> mutations, respectively. An elevated CEA level (>192 ng/mL) was the most sensitive test for the detection of a mucinous cystic lesion (62.5%) versus <italic>KRAS</italic> mutation (56%) and "positive" cytology (61.5%). <italic>KRAS</italic> mutations were identified in 2 of 25 mucinous cystic lesions (8%) in which cytology and CEA levels were not contributory.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>CONCLUSIONS</title> <p>A volume‐based protocol using different components of the specimen was able to optimize diagnostic yield in pancreatic cyst fluids. <italic>KRAS</italic> mutation testing increased diagnostic yield when combined with cytology and CEA analysis. The current results demonstrated that supernatant is comparable to neat fluid and cell block material for CEA and <italic>KRAS</italic> testing. Cancer (Cancer Cytopathol) 2013. © 2012 American Cancer Society.</p> </sec> </abstract>