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Cell block processing is optimal for assessing endoscopic ultrasound fine needle aspiration specimens of pancreatic mucinous cysts
  1. Newton A C S Wong1,
  2. Paida Gwiti1,
  3. Timothy Murigu1,
  4. Zsombor Melegh1,
  5. Sophie Beavers1,
  6. Fiona Gordon2,
  7. Efstratios Alexandridis2,
  8. Sally Norton2
  1. 1 Department of Cellular Pathology, Southmead Hospital, Bristol, UK
  2. 2 Queens Day Unit, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Dr Newton A C S Wong, Cellular Pathology, Southmead Hospital, Bristol BS10 5NB, UK; Nacs.Wong{at}


Aims The cell block technique for assessing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) specimens from pancreatic mucinous cystic lesions (MCLs) was systematically evaluated for the first time, including comparisons with three traditional methods of assessing such specimens.

Methods The prospective arm comprised EUS-FNA specimens from EUS-suspected pancreatic MCLs. The retrospective arm comprised EUS-FNA specimens from pancreatic MCLs surgically resected before the study start. For each specimen, these data points were collected: macroscopic likelihood of mucin, cyst fluid carcinoembryonic antigen (CEA) level and presence of mucin in air-dried, direct smears and in cell block preparations.

Results The prospective and retrospective arms of the study comprised 80 and 30 EUS-FNA specimens, respectively. Seven prospective cases led to surgical resections during the study, and therefore, 37 EUS-FNA specimens were confirmed to have originated from MCLs. In the prospective arm, macroscopic mucin was suspected, cyst fluid CEA level exceeded 192 ng/mL, mucin was detected in direct smears and cell block preparations in 78%, 30%, 39% and 73% of cases, respectively. Of the 37 specimens confirmed to originate from MCLs, macroscopic mucin assessment, cyst fluid CEA level, direct smear mucin assessment and cell block mucin assessment had sensitivities for diagnosing MCL of 87%, 45%, 45% and 81%, respectively.

Conclusions Cell block preparations are as likely to identify mucin from pancreatic MCLs as macroscopic assessment but are twice as likely to diagnose MCL than direct smears and fluid CEA biochemistry. The cell block technique is easy for sample collection and processing especially because these are identical for solid and cystic pancreatic lesions.

  • pancreas
  • cyst
  • fine needle aspiration
  • cell block
  • sensitivity

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  • Handling editor Runjan Chetty.

  • Contributors NACSW conceived the idea for this study. PG and TM compiled the data. NACSW, ZM and SB assessed the endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) specimens. FG, EA and SN generated and macroscopically assessed the EUS-FNA specimens. All authors contributed to the preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.