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Endoscopic-ultrasound-guided fine-needle aspiration and the role of the cytopathologist in solid pancreatic lesion diagnosis.

Iqbal S, Friedel D, Gupta M, Ogden L, Stavropoulos SN - Patholog Res Int (2012)

Bottom Line: The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features.A close interaction with the cytopathologist is required in improving the diagnostic yield.Day to day examples of different solid pancreatic lesions have been presented at the end.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Winthrop-University Hospital, Mineola, NY 1150, USA.

ABSTRACT
Endoscopic ultrasound (EUS) is the most sensitive imaging modality for solid pancreatic lesions. The specificity, however, is low (about 75%). It can be increased to 100% with an accuracy of 95% by the addition of fine-needle aspiration (FNA). Cytopathology plays an important role. The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features. A close interaction with the cytopathologist is required in improving the diagnostic yield. In this paper, we present an overview of the role of EUS-guided FNA and importance of close interaction with the cytopathologist. Day to day examples of different solid pancreatic lesions have been presented at the end.

No MeSH data available.


Related in: MedlinePlus

Pancreatic ductal adenocarcinoma, well-differentiated: (a) normal pancreatic ductal epithelium, Papanicolaou stain at 400x; (b) nuclear membrane irregularities, Papanicolaou stain at 600x; (c) well-differentiated adenocarcinoma with “drunken honeycombs,” Papanicolaou stain at 400x.
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Related In: Results  -  Collection


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fig7: Pancreatic ductal adenocarcinoma, well-differentiated: (a) normal pancreatic ductal epithelium, Papanicolaou stain at 400x; (b) nuclear membrane irregularities, Papanicolaou stain at 600x; (c) well-differentiated adenocarcinoma with “drunken honeycombs,” Papanicolaou stain at 400x.

Mentions: Onsite evaluation for a poorly differentiated adenocarcinoma is relatively easy because of increased cellularity and markedly atypical clusters with a 3-dimensional appearance (Figure 6). Necrosis may be evident in the background. On the other hand, a well-differentiated adenocarcinoma can be challenging even on alcohol fixed and Papanicolaou-stained smears. The key is to establish at least one completely normal ductal epithelium which would have uniformly sized, bland nuclei, equidistant from each other, giving it a honeycombed appearance (Figure 7). All other cell groups are compared to this normal standard. In a well-differentiated adenocarcinoma, the four most outstanding differences from normal epithelium are overall larger nuclei as compared to normal; nuclear size variation such that the largest nucleus in the group may be three times the smallest nucleus; unequal spacing of nuclei resulting in a loss of polarity, also referred to as “drunken honeycombs”; nuclear grooves and nuclear membrane irregularities [41]. If these features are not specifically sought, a false negative diagnosis may be rendered.


Endoscopic-ultrasound-guided fine-needle aspiration and the role of the cytopathologist in solid pancreatic lesion diagnosis.

Iqbal S, Friedel D, Gupta M, Ogden L, Stavropoulos SN - Patholog Res Int (2012)

Pancreatic ductal adenocarcinoma, well-differentiated: (a) normal pancreatic ductal epithelium, Papanicolaou stain at 400x; (b) nuclear membrane irregularities, Papanicolaou stain at 600x; (c) well-differentiated adenocarcinoma with “drunken honeycombs,” Papanicolaou stain at 400x.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3362237&req=5

fig7: Pancreatic ductal adenocarcinoma, well-differentiated: (a) normal pancreatic ductal epithelium, Papanicolaou stain at 400x; (b) nuclear membrane irregularities, Papanicolaou stain at 600x; (c) well-differentiated adenocarcinoma with “drunken honeycombs,” Papanicolaou stain at 400x.
Mentions: Onsite evaluation for a poorly differentiated adenocarcinoma is relatively easy because of increased cellularity and markedly atypical clusters with a 3-dimensional appearance (Figure 6). Necrosis may be evident in the background. On the other hand, a well-differentiated adenocarcinoma can be challenging even on alcohol fixed and Papanicolaou-stained smears. The key is to establish at least one completely normal ductal epithelium which would have uniformly sized, bland nuclei, equidistant from each other, giving it a honeycombed appearance (Figure 7). All other cell groups are compared to this normal standard. In a well-differentiated adenocarcinoma, the four most outstanding differences from normal epithelium are overall larger nuclei as compared to normal; nuclear size variation such that the largest nucleus in the group may be three times the smallest nucleus; unequal spacing of nuclei resulting in a loss of polarity, also referred to as “drunken honeycombs”; nuclear grooves and nuclear membrane irregularities [41]. If these features are not specifically sought, a false negative diagnosis may be rendered.

Bottom Line: The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features.A close interaction with the cytopathologist is required in improving the diagnostic yield.Day to day examples of different solid pancreatic lesions have been presented at the end.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Winthrop-University Hospital, Mineola, NY 1150, USA.

ABSTRACT
Endoscopic ultrasound (EUS) is the most sensitive imaging modality for solid pancreatic lesions. The specificity, however, is low (about 75%). It can be increased to 100% with an accuracy of 95% by the addition of fine-needle aspiration (FNA). Cytopathology plays an important role. The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features. A close interaction with the cytopathologist is required in improving the diagnostic yield. In this paper, we present an overview of the role of EUS-guided FNA and importance of close interaction with the cytopathologist. Day to day examples of different solid pancreatic lesions have been presented at the end.

No MeSH data available.


Related in: MedlinePlus