Subject(s)
Gastroscopy/methods , Narrow Band Imaging , Stomach Neoplasms/diagnosis , Female , Humans , MaleABSTRACT
BACKGROUND: Pancreatic cysts are being increasingly identified in patients. Mucinous cysts have malignant potential whereas non-mucinous cysts do not. Distinguishing potentially malignant cysts from harmless ones by the characterization of cyst fluid contents remains a difficult problem. This study was undertaken to determine whether cyst fluid mucin glycoprotein analysis could differentiate mucinous from non-mucinous pancreatic cysts. METHODS: Cyst fluid from 28 patients who underwent resection of a pancreatic cyst was used for the study. In each case the type of cyst was histologically identified. One dimensional SDS polyacrylamide gel electrophoresis (1D-SDS PAGE) was performed on cyst fluid samples. For the detection of the separated proteins, we employed a novel dual staining technique. The gel was first stained with periodic acid Schiff (PAS), a mucin histochemical stain followed by a secondary protein staining with Simply Blue Safestain (Invitrogen). RESULTS: Visual scoring (based on the presence of mucins) gave a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 88% for prediction of mucinous histology. CONCLUSIONS: One dimensional SDS polyacrylamide gel electrophoresis of pancreatic cyst fluid, followed by mucin (PAS) and protein (Simply Blue Safestain) staining, provides a means of concentrating and visualizing mucins, which allows the accurate differentiation of mucinous from non-mucinous histology in pancreatic cysts.
ABSTRACT
BACKGROUND & AIMS: Mural nodules predict malignancy within pancreatic cysts, but it is not clear whether endoscopic ultrasound (EUS) and computed tomography (CT) accurately identify nodules. We assessed images and the histology of mural nodules in branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) and mucinous cystic neoplasms (MCNs) and identified criteria to distinguish mural nodules from mucus. METHODS: We reviewed pathology specimens and EUS and CT images from consecutive patients with resected BD-IPMNs or MCNs. A blinded interobserver study of the EUS images was then conducted to identify features that distinguished nodules from mucus. After education about these features, the raters interpreted the EUS images again. RESULTS: On the basis of histologic analysis, 22 of 57 cases had epithelial nodules. Cancer or high-grade dysplasia was found in 23% of cysts with nodules versus 3% without nodules (P = .02). On the basis of reports, EUS detected epithelial nodules with 75% sensitivity and 83% specificity, whereas these values were 24% and 100%, respectively, for CT. Mucus accounted for 65% of intracystic lesions detected by EUS and was often diagnosed by using change in body position and fine-needle aspiration. Interobserver analysis identified 3 features that were detected by EUS (echogenicity, edge, and rim) that distinguished mucus from epithelial nodules. The diagnostic accuracy of the raters improved from a mean of 57% to 79% after education about these features (P = .004); accuracy was 90% when all 3 features of mucus were present. CONCLUSIONS: Malignancy is associated with epithelial nodules in BD-IPMNs and MCNs, but most echogenic lesions detected in cysts by EUS are mucus. Knowledge of features that discriminate mucus from mural nodules improves the diagnostic accuracy of EUS.
Subject(s)
Common Bile Duct Neoplasms/pathology , Neoplasms, Cystic, Mucinous, and Serous/pathology , Pancreatic Cyst/pathology , Aged , Common Bile Duct Neoplasms/diagnostic imaging , Diagnosis, Differential , Endosonography , Female , Histocytochemistry , Humans , Male , Middle Aged , Mucus/diagnostic imaging , Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging , Neoplasms, Glandular and Epithelial/pathology , Pancreatic Cyst/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Several applications of the University of Colorado Visible Human project have recently been developed in clinical gastroenterology, including a textbook of endoscopic ultrasound anatomy, an internet-based journal, articles on internet web-sites, and simulators. Details surrounding some of these projects are described.
Subject(s)
Diagnostic Imaging/methods , Endosonography/methods , Gastroenterology/methods , Gastrointestinal Diseases/diagnosis , Imaging, Three-Dimensional , Visible Human Projects , Colorado , Gastroenterology/education , Humans , National Library of Medicine (U.S.) , United StatesABSTRACT
In this pilot study of 21 adults, direct collection versus cotton-ball collection of urine was studied. Results showed the use of cotton balls for collecting urine is a safe and effective method for measuring antioxidants and markers of oxidative stress for clinical and research use.
