Open Access Research article

The added value of using mutational profiling in addition to cytology in diagnosing aggressive pancreaticobiliary disease: review of clinical cases at a single center

Nidhi Malhotra1, Sara A Jackson2*, Lindsay L Freed2, Mindi A Styn2, Mary K Sidawy3, Nadim G Haddad1 and Sydney D Finkelstein24

Author Affiliations

1 Medstar Georgetown University Hospital, Division of Gastroenterology, Washington, DC, USA

2 RedPath Integrated Pathology, Inc., Pittsburgh, PA, USA

3 Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA

4 Department of Pathology, Drexel University, Philadelphia, PA, USA

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BMC Gastroenterology 2014, 14:135  doi:10.1186/1471-230X-14-135

Published: 1 August 2014

Abstract

Background

This study aimed to better understand the supporting role that mutational profiling (MP) of DNA from microdissected cytology slides and supernatant specimens may play in the diagnosis of malignancy in fine-needle aspirates (FNA) and biliary brushing specimens from patients with pancreaticobiliary masses.

Methods

Cytology results were examined in a total of 30 patients with associated surgical (10) or clinical (20) outcomes. MP of DNA from microdissected cytology slides and from discarded supernatant fluid was analyzed in 26 patients with atypical, negative or indeterminate cytology.

Results

Cytology correctly diagnosed aggressive disease in 4 patients. Cytological diagnoses for the remaining 26 were as follows: 16 negative (9 false negative), 9 atypical, 1 indeterminate. MP correctly determined aggressive disease in 1 false negative cytology case and confirmed a negative cytology diagnosis in 7 of 7 cases of non-aggressive disease. Of the 9 atypical cytology cases, MP correctly diagnosed 7 as positive and 1 as negative for aggressive disease. One specimen that was indeterminate by cytology was correctly diagnosed as non-aggressive by MP. When first line malignant (positive) cytology results were combined with positive second line MP results, 12/21 cases of aggressive disease were identified, compared to 4/21 cases identified by positive cytology alone.

Conclusions

When first line cytology results were uncertain (atypical), questionable (negative), or not possible (non-diagnostic/indeterminate), MP provided additional information regarding the presence of aggressive disease. When used in conjunction with first line cytology, MP increased detection of aggressive disease without compromising specificity in patients that were difficult to diagnose by cytology alone.

Keywords:
Pancreatic cyst; Pancreatic cancer; Molecular analysis