Diagnostic utility of mucin profile in fine-needle aspiration specimens of the pancreas

An immunohistochemical study with surgical pathology correlation

Authors

  • Tamar A. Giorgadze M.D., Ph.D.,

    1. Department of Pathology, East Tennessee State University, Johnson City, Tennessee
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  • Heather Peterman M.D.,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Zubair W. Baloch M.D., Ph.D.,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Emma E. Furth M.D.,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Theresa Pasha B.S.,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Natsuko Shiina CT(ASCP)IAC,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Paul J. Zhang M.D.,

    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Prabodh K. Gupta M.D.

    Corresponding author
    1. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
    • Division of Cytopathology and Cytometry, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street/6 Founders, Philadelphia, PA 19104
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    • Fax: (215) 662-6518


  • Presented in part as a platform presentation at the 52nd Annual Scientific Meeting of the American Society of Cytopathology, Chicago, IL, November 12–17, 2004.

Abstract

BACKGROUND

The cytologic differentiation between neoplastic and reactive/reparative processes in the endoscopic ultrasound-guided fine-needle aspirations (EUS-FNA) of the pancreas can be difficult. Malignant transformation of the pancreatic ductal epithelium changes the expression of apomucins. The goal of the current study was to determine an optimal immunohistochemical panel of mucin (MUC) antibodies that would allow the cytomorphologic distinction of pancreatic ductal adenocarcinoma and its differentiation from reactive/reparative processes and inadvertently sampled gastric and duodenal mucosa.

METHODS

Pancreatic EUS-FNA specimens performed on 351 patients were reviewed. Expression profiles of MUC1, 2, 5AC, and 6 were examined on 56 cell block sections and 26 follow-up pancreatectomy specimens.

RESULTS

MUC1 and 6 expression was found in nonneoplastic pancreatic samples, whereas there was an absence of expression of MUC2 and 5AC. MUC2 was detected in mucosal goblets cells of the duodenum, MUC6 in Brunner glands, and MUC5AC in gastric foveolar cells. MUC5AC expression in differentiating ductal adenocarcinomas from benign conditions demonstrated better operating characteristics than either MUC1 or MUC6. The apomucin expression pattern both in cytology and follow-up surgical pathology specimens was similar. In surgical pathology specimens, the panel of 3 antibodies, MUC1+/MUC2−/MUC5AC+, was noted in 15 of 17 ductal carcinomas (88.2%). In nonneoplastic pancreatic tissue, the expression panel MUC1+/MUC2−/MUC5AC− was observed in 14 of 17 (82.4%) cases. In cytology specimens, the combination of MUC1+/MUC2−/MUC5AC+ was noted in 21 of 30 ductal carcinoma cases (70.0%), 3 of 6 atypical cases (50%), and 1 of 1 suspicious for malignancy cases (100%). The combination MUC1+/MUC2−/MUC5AC+ was not observed in any of the negative for malignancy or reactive cases (0 of 6).

CONCLUSIONS

The most optimal panel for the diagnosis of ductal adenocarcinoma in both the EUS-FNA specimens is a panel including MUC1/MUC2/MUC5AC, whereas a panel of all 4 antibodies (MUC1, 2, 5AC, and 6) will in addition aid in differentiating inadvertently sampled normal/reactive duodenal and gastric epithelium from neoplastic pancreatic tissue. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

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