title: Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts.
abstract: OBJECTIVE
  Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines.
  
  
  BACKGROUND
  The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage.
  
  
  METHODS
  We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [≥high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated.
  
  
  RESULTS
  Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features.
  
  
  CONCLUSIONS
  Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.
authors: Department of Pathology, The James Homer Wright Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors: Muriel
authors: M
authors: Genevay
authors: Mari
authors: M
authors: Mino-Kenudson
authors: Kurt
authors: K
authors: Yaeger
authors: Ioannis T
authors: IT
authors: Konstantinidis
authors: Cristina R
authors: CR
authors: Ferrone
authors: Sarah
authors: S
authors: Thayer
authors: Carlos Fernandez-del
authors: CF
authors: Castillo
authors: Dushyant
authors: D
authors: Sahani
authors: Brenna
authors: B
authors: Bounds
authors: David
authors: D
authors: Forcione
authors: William R
authors: WR
authors: Brugge
authors: Martha Bishop
authors: MB
authors: Pitman
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000368:Aged; D044963:Biopsy, Fine-Needle; D002278:Carcinoma in Situ / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D015331:Cohort Studies; D018282:Cystadenocarcinoma, Mucinous / Q000473:pathology*; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010181:Pancreatic Cyst / Q000473:pathology*; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional