O144 The role of cytology in the investigation and management of cystic lesions of the pancreas with special reference to mucinous cystic neoplasms

Abstract

Abstract Introduction Pancreatic cystic lesions encompass benign and malignant disease within the pancreas. Cytology has been increasingly used in the physician's toolbox to provide an accurate, non-invasive and cost-effective modality for the diagnosis of pancreatic lesions. The cytological appearance alone may be insufficient to establish the diagnosis and it's crucial for effective clinicopathological correlation in a multidisciplinary setting, highlighting the vital role of the pathologist to ensure effective and quality care. Methods We identified 178 cases of cystic lesions of the pancreas between 2017 and 2021. We used the C grading system and the Papanicolaou grading systems (Pap) to assess the potential risk of malignancy. Results We identified 20 cases with moderate and high grade intraductal papillary mucinous neoplasms (IPMN) and 12 cases of mucinous cystic neoplasms (MCN) by using the Pap grading system, 18% that may require surgical intervention. 39 cases (22%) are low grade IPMN. 72 cases are classified as high risk and potentially malignant (Pap grade 4b) in comparison with 25 cases, using the C grading (C4 and C5). The remaining cases 77 (43%) are benign to very low risk malignant potential that don't require surgical intervention. Conclusion The use of Pap grading allowed for a less invasive approach to tissue sampling which, when combined with routine staining and specialised immunohistochemistry can help establish the diagnosis and parameters associated with progressive malignancy. The study provides a powerful non-invasive diagnostic tool that helps in surgical decision making for patients with cystic lesions of the pancreas.