title: Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms.
abstract: BACKGROUND
  Mucinous cystic neoplasms (MCNs) of the pancreas present a management conundrum. The majority are benign but all are resected due to their malignant potential. Recent studies have recommended nonsurgical management. In the current study, the authors analyzed the preoperative imaging, cytology, and cyst fluid characteristics of 136 histologically confirmed MCNs to assess predictors of a high-risk (HR) cyst for surgical triage.
  
  
  METHODS
  MCNs resected at the Massachusetts General Hospital between 1990 and 2014 formed the study cohort. Patient demographics, cyst size, and mural nodules (MNs) by endoscopic ultrasound, cytology, and cyst fluid carcinoembryonic antigen and amylase levels were correlated with histological grade. A HR cyst was defined as high-grade dysplasia or invasive carcinoma on histology. Performance characteristics were assessed for each parameter, with a cyst size ≥3 cm or a MN on imaging and malignant cytology considered to be "true-positive" results for predicting malignancy.
  
  
  RESULTS
  Only 15 of the 136 cysts had HR histology (11%). On average, patients with HR cysts were older than those with low-risk cysts (55 years vs 49 years, respectively). High-grade cytology was the most accurate predictor of malignancy (95%) followed by MN and cyst size together (88%) and MN alone (83%). The average carcinoembryonic antigen level (in ng/mL) increased with the grade of dysplasia but the ranges overlapped between low risk and HR cysts.
  
  
  CONCLUSIONS
  To the authors' knowledge, the current study is the largest series to date analyzing the cytological features of histologically confirmed MCN. Cytology is insensitive but very specific for detecting a HR MCN and outperformed imaging for the detection of HR MCN. Endoscopic ultrasound-guided fine-needle aspiration and cytology should be performed on any clinically suspected MCN that is being considered for conservative management. Cancer Cytopathol 2017;125:169-177. © 2016 American Cancer Society.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Aristana
authors.initials: A
authors.lastname: Scourtas
authors.affiliation: Department of Pathology, Stanford University Medical Center, Palo Alto, California.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Dudley
authors.affiliation: Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.affiliation: Division of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kadayifci
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Pitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D057234:Preoperative Period; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics
chemical_list: D002272:Carcinoembryonic Antigen; C117307:KRAS protein, human; D000681:Amylases; D016283:Proto-Oncogene Proteins p21(ras)
keywords: cytology; endoscopic ultrasound (EUS); fine-needle aspiration (FNA); mucinous cystic neoplasm; pancreas