Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions

Nicole C. Panarelli, Raanan Sela, Andrew M. Schreiner, John P. Crapanzano, David S. Klimstra, Felice Schnoll-Sussman, Mark B. Pochapin, Rhonda K. Yantiss

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35%) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.

Original languageEnglish (US)
Pages (from-to)1434-1443
Number of pages10
JournalAmerican Journal of Surgical Pathology
Volume36
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Cysts
Pancreatic Cyst
Cell Biology
Serous Cystadenoma
Neoplasms
Clinical Laboratory Techniques
Loss of Heterozygosity
Carcinoembryonic Antigen
Fine Needle Biopsy
Diagnostic Errors
Tumor Suppressor Genes
Pancreatitis
Microsatellite Repeats
Biomarkers
Observation
Pathology
Mutation
DNA

Keywords

  • endoscopic ultrasound
  • fine-needle aspiration biopsy
  • mucinous
  • pancreas
  • PathfinderTG
  • Redpath Integrated Pathology

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Panarelli, N. C., Sela, R., Schreiner, A. M., Crapanzano, J. P., Klimstra, D. S., Schnoll-Sussman, F., ... Yantiss, R. K. (2012). Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions. American Journal of Surgical Pathology, 36(10), 1434-1443. https://doi.org/10.1097/PAS.0b013e31825d534a

Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions. / Panarelli, Nicole C.; Sela, Raanan; Schreiner, Andrew M.; Crapanzano, John P.; Klimstra, David S.; Schnoll-Sussman, Felice; Pochapin, Mark B.; Yantiss, Rhonda K.

In: American Journal of Surgical Pathology, Vol. 36, No. 10, 10.2012, p. 1434-1443.

Research output: Contribution to journalArticle

Panarelli, NC, Sela, R, Schreiner, AM, Crapanzano, JP, Klimstra, DS, Schnoll-Sussman, F, Pochapin, MB & Yantiss, RK 2012, 'Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions', American Journal of Surgical Pathology, vol. 36, no. 10, pp. 1434-1443. https://doi.org/10.1097/PAS.0b013e31825d534a
Panarelli, Nicole C. ; Sela, Raanan ; Schreiner, Andrew M. ; Crapanzano, John P. ; Klimstra, David S. ; Schnoll-Sussman, Felice ; Pochapin, Mark B. ; Yantiss, Rhonda K. / Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions. In: American Journal of Surgical Pathology. 2012 ; Vol. 36, No. 10. pp. 1434-1443.
@article{03b52a2ac97c4fb49c106151d4ba1ea6,
title = "Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions",
abstract = "The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35{\%}) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.",
keywords = "endoscopic ultrasound, fine-needle aspiration biopsy, mucinous, pancreas, PathfinderTG, Redpath Integrated Pathology",
author = "Panarelli, {Nicole C.} and Raanan Sela and Schreiner, {Andrew M.} and Crapanzano, {John P.} and Klimstra, {David S.} and Felice Schnoll-Sussman and Pochapin, {Mark B.} and Yantiss, {Rhonda K.}",
year = "2012",
month = "10",
doi = "10.1097/PAS.0b013e31825d534a",
language = "English (US)",
volume = "36",
pages = "1434--1443",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Commercial molecular panels are of limited utility in the classification of pancreatic cystic lesions

AU - Panarelli, Nicole C.

AU - Sela, Raanan

AU - Schreiner, Andrew M.

AU - Crapanzano, John P.

AU - Klimstra, David S.

AU - Schnoll-Sussman, Felice

AU - Pochapin, Mark B.

AU - Yantiss, Rhonda K.

PY - 2012/10

Y1 - 2012/10

N2 - The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35%) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.

AB - The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35%) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.

KW - endoscopic ultrasound

KW - fine-needle aspiration biopsy

KW - mucinous

KW - pancreas

KW - PathfinderTG

KW - Redpath Integrated Pathology

UR - http://www.scopus.com/inward/record.url?scp=84866633295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866633295&partnerID=8YFLogxK

U2 - 10.1097/PAS.0b013e31825d534a

DO - 10.1097/PAS.0b013e31825d534a

M3 - Article

C2 - 22982886

AN - SCOPUS:84866633295

VL - 36

SP - 1434

EP - 1443

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 10

ER -