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Published online: September 29, 2020

Centeno BA, Dhillon J (eds): Pancreatic Tumors. Monogr Clin Cytol. Basel, Karger, 2020, vol 26, pp VI–VII (DOI:10.1159/000506356)

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Preface

Image-guided fine-needle aspiration (FNA) of the pancreas using either transabdominal ultrasound or CT scan was first utilized and reported in the 1970s, eventually replacing laparotomy with wedge biopsy of the pancreas as the favored means of sampling pancreatic masses. In fact, this was the state of the field when the senior editor, Dr. Centeno was first introduced to pancreatic cytopathology as a first-year resident in 1988–1989. Endoscopic ultrasound (EUS)-guided FNA was first reported in 1992 as a means of guiding pancreatic aspiration. Initially received with some skepticism, it is now the preferred method used to perform FNA of the pancreas in many institutions throughout the world. The specific imaging features of many pancreatic lesions, using CT scan, transabdominal ultrasound, EUS, and now more advanced methods, such as magnetic resonance imaging and magnetic resonance cholangiopancreatography, have been described in detail.

Early publications on the cytology of the pancreas described the cytological features of ductal adenocarcinoma and its distinction from pancreatitis. As experience increased, the 1980s and 1990s saw numerous publications describing the cytological features of non-ductal neoplasms, as well as uncommon entities such as solid pseudopapillary neoplasm, formerly known as Frantz tumor, and pancreatoblastoma. A robust body of work also led to the development of increasingly specific criteria for the challenging diagnosis of pancreatic ductal adenocarcinoma. Pancreatic cyst cytology was the next frontier of pancreatic cytology to be explored in the 1990s. In fact, the senior editor’s first project in pancreatic cytopathology – started in her fellowship year in cytopathology – was to describe the cytological features of pancreatic cyst aspirates, derived from resection specimens. The recognition of the distinction of mucinous from non-mucinous lesions using cytology and measuring CEA cyst fluid levels was the next advance. FNA of pancreatic cysts is now accepted as part of the management protocol of patients with pancreatic cysts.

Yet, despite improved understanding of the cytological features of many entities, there remained challenging entities for which sensitivity of cytopathology is variable. More recently, evolution of the understanding of the genetics of pancreatic neoplasms has led to the development of immunohistochemical antibodies and molecular panels that provide more specific diagnoses and prognoses.

Pancreatic cytology is best practiced in a multidisciplinary manner. Accurate interpretation of the pancreatic cytology sample requires correlation of the clinical, imaging, cytological, and ancillary test findings. This volume provides the reader with the information necessary to assess a cytological specimen of the pancreas using a multidisciplinary approach. It describes and illustrates the cytological criteria of the most common non-neoplastic, neoplastic, and cystic lesions of the pancreas, and includes the pertinent clinical, imaging, and ancillary testing. A solid understanding of the histopathology of pancreatic lesions is also required to better evaluate pancreatic cytology. The histological features are included, and an approach to the differential diagnoses and potential pitfalls is reviewed.

This book provides a comprehensive review of entities that may be encountered in pancreatic cytology. It is designed for cytotechnologists, pathology trainees, pathologists, and cytopathologists. It is also a useful guide for advanced endoscopists performing EUS-guided FNA, and surgeons and oncologists treating patients with pancreatic disease wanting to understand their pathology reports.

The work presented here is the product of years of experience and curiosity of the senior editor, Dr. Centeno, who has witnessed the evolving landscape of pancreatic cytology, since the inception of EUS-guided FNA and pancreatic cyst fluid cytology. Dr. Centeno is honored to share her experience with the reader and to educate and mentor, with her colleague, Dr. Dhillon, the next generation of cytopathologists.

Barbara A. Centeno, Tampa, FL

Jasreman Dhillon, Tampa, FL