Fine Needle Aspiration Diagnosis of Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms of the Pancreas: Cytomorphology, CEA Level and KRAS Mutation Status
Xiangbai Chen, M.D., Berrin Ustun, M.D., Jane Bernstein, M.D., Harry R. Aslanian, M.D., David Chhieng, M.D., Guoping Cai, M.D.
Departments of Pathology and Internal Medicine, Yale School of Medicine, New Haven, CT, USA
INTRODUCTION
Mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN) are the two most common mucinous lesions in the pancreas. Recognition of these mucinous lesions preoperatively is important due to their potential association with variable dysplasia and even invasive carcinoma. Since the patients with invasive MCNs are 5-10 years older than the patient with noninvasive MCNs, suggesting that progression from a noninvasive curable neoplasm to an invasive cancer occurs over a a period of years. Similar findings are also seen in the patients with IPMNs.
With advances in imaging techniques, more and more pancreatic lesions are identified. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is becoming the choice of modality for diagnosing and classifying pancreatic lesions. However, accurate diagnosis of pancreatic lesions, especially cystic lesions, could be difficult based on cytomorphologic features alone due to low cellularity and overlapping cytomorphology. Previous studies have demonstrated that carcinoembryonic antigen (CEA) level analysis of cystic fluids could be helpful in differentiating mucinous from non-mucinous cysts. KRAS mutation has been implicated in pathogenesis of pancreatic neoplasms and KRAS mutation testing can improve diagnostic yield in cases with indeterminate cytological diagnoses.
In this retrospective study, we review the results of cytological diagnosis, CEA level and KRAS mutation status in MCNs and IPMNs diagnosed by histopathologic examination.
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