Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Pancreatic Neoplasms: HELP
Articles by Lester J. Layfield
Based on 15 articles published since 2010
(Why 15 articles?)
||||

Between 2010 and 2020, Lester Layfield wrote the following 15 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions: the Papanicolaou Society of Cytopathology guidelines for pancreatobiliary cytology. 2014

Layfield, Lester J / Ehya, Hormoz / Filie, Armando C / Hruban, Ralph H / Jhala, Nirag / Joseph, Loren / Vielh, Philippe / Pitman, Martha B / Anonymous3080788. ·Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri. ·Diagn Cytopathol · Pubmed #24639398.

ABSTRACT: The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound-guided fine-needle aspiration, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and post-biopsy management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings, and synthesis of selected online comments of the draft document. This document presents the results of these discussions regarding the use of ancillary testing in the cytologic diagnosis of biliary and pancreatic lesions. Currently, fluorescence in situ hybridization (FISH) appears to be the most clinically relevant ancillary technique for cytology of bile duct strictures. The addition of FISH analysis to routine cytologic evaluation appears to yield the highest sensitivity without loss in specificity. Loss of immunohistochemical staining for the protein product of the SMAD4 gene and positive staining for mesothelin support a diagnosis of ductal adenocarcinoma. Immunohistochemical markers for endocrine and exocrine differentiation are sufficient for a diagnosis of endocrine and acinar tumors. Nuclear staining for beta-catenin supports a diagnosis of solid-pseudopapilary neoplasm. Cyst fluid analysis for amylase and carcinoembryonic antigen aids in the preoperative classification of pancreatic cysts. Many gene mutations (KRAS, GNAS, VHL, RNF43, and CTNNB1) may be of aid in the diagnosis of cystic neoplasms. Other ancillary techniques do not appear to improve diagnostic sensitivity sufficiently to justify their increased costs.

2 Guideline Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines. 2014

Pitman, Martha B / Centeno, Barbara A / Ali, Syed Z / Genevay, Muriel / Stelow, Ed / Mino-Kenudson, Mari / Fernandez-del Castillo, Carlos / Max Schmidt, C / Brugge, William / Layfield, Lester / Anonymous9540785. ·Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·Diagn Cytopathol · Pubmed #24554455.

ABSTRACT: The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and postbiopsy treatment and management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18-month period and synthesis of online comments of the draft document on the Papanicolaou Society of Cytopathology web site (www.papsociety.org). This document selectively presents the results of these discussions and focuses on a proposed standardized terminology scheme for pancreatobiliary specimens that correlate cytological diagnosis with biological behavior and increasingly conservative patient management of surveillance only. The proposed terminology scheme recommends a six-tiered system: Nondiagnostic, Negative, Atypical, Neoplastic (benign or other), Suspicious and Positive. Unique to this scheme is the "Neoplastic" category separated into "benign" (serous cystadenoma), or "Other" (premalignant mucinous cysts, neuroendocrine tumors, and solid-pseudopapillary neoplasms). The positive or malignant category is reserved for high-grade, aggressive malignancies including ductal adenocarcinoma, acinar cell carcinoma, poorly differentiated neuroendocrine carcinomas, pancreatoblastoma, lymphoma, and metastases. Interpretation categories do not have to be used. Some pathology laboratory information systems require an interpretation category, which places the cytological diagnosis into a general category. This proposed scheme provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology. In addition, this terminology scheme attempts to provide maximum flexibility for patient management, which has become increasingly conservative for some neoplasms.

3 Review Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review. 2014

Pitman, Martha B / Layfield, Lester J. ·Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts. ·Cancer Cytopathol · Pubmed #24777782.

ABSTRACT: The newest installment on state-of-the-art standards of practice in cytopathology from the Papanicolaou Society of Cytopathology (PSC) focuses on the pancreaticobiliary system. Similar to the National Cancer Institute recommendations for aspiration cytology of the thyroid, the PSC guidelines for pancreaticobiliary cytology addresses indications, techniques, terminology and nomenclature, ancillary studies, and postprocedure management. Each committee was composed of a multidisciplinary group of experts in diagnosing, managing, and treating patients with pancreaticobiliary disease. Draft documents were posted on an interactive Web-based forum hosted by the PSC Web site (www.papsociety.org) and the topics of terminology, ancillary testing, and management were presented at national and international meetings over an 18-month period for discussion and feedback from practicing pathologists around the world. This review provides a synopsis of these guidelines.

4 Article Interobserver reproducibility and agreement with original diagnosis in the categories "atypical" and "suspicious for malignancy" for bile and pancreatic duct brushings. 2015

Layfield, Lester J / Schmidt, Robert L / Chadwick, Barbara E / Esebua, Magda / Witt, Benjamin L. ·University of Missouri, Columbia, Missouri. · University of Utah and ARUP Laboratories, Salt Lake City, Utah. ·Diagn Cytopathol · Pubmed #26153872.

ABSTRACT: BACKGROUND: The Papanicolaou Society of Cytopathology has developed a set of guidelines which include a diagnostic scheme with the categories "atypical" and "suspicious for malignancy." These intermediate categories may help stratify risk of malignancy for samples obtained from the bile and pancreatic ducts. However, the reproducibility of these intermediate categories is currently unknown. METHODS: Twenty sequential brushing specimens of bile or pancreatic ducts from each of the categories "atypical" and "suspicious for malignancy" were identified and the slides retrieved. All 40 cases were reviewed independently by four cytopathologists blinded to the original diagnoses. Resulting review diagnoses were statistically analyzed for agreement and the Kappa statistic calculated. Agreement of the observers' diagnoses with original diagnoses was also evaluated. RESULTS: Interobserver agreement was graded as slight to fair with observers agreeing in about 50% of cases. The corresponding kappa statistic for the category "atypical" was 0.21 and 0.18 for the category "suspicious for malignancy." Reviewer agreement with the original reference diagnosis occurred in approximately one half of review diagnoses. CONCLUSION: Analysis of agreement shows that interobserver agreement was only slight to fair. Despite the categories "atypical" and "suspicious for malignancy" having distinct risks of malignancy (62% versus 74%), the reproducibility of these categories is relatively poor. A single intermediate category may improve reproducibility over the scheme proposed by the Papanicolaou Society of Cytopathology while maintaining an ability to stratify risk of malignancy.

5 Article Risk stratification using cytomorphologic features in endoscopic ultrasonographic-guided fine-needle aspiration diagnosis of pancreatic ductal adenocarcinoma. 2015

Huffman, Brandon M / Esebua, Magda / Layfield, Lester J / Witt, Benjamin L / Schmidt, Robert L. ·Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri. · Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah. ·Diagn Cytopathol · Pubmed #25914403.

ABSTRACT: BACKGROUND: Endoscopic ultrasonographic-guided fine-needle aspiration (EUS-FNA) is the procedure of choice for the investigation of pancreatic lesions. It shows good sensitivity and excellent specificity. Diagnostic criteria have been published but not statistically validated for the diagnosis of malignancy and stratification of risk for malignancy. METHODS: A training set of 57 EUS-FNAs and the validation set of 107 EUS-FNAs were selected. Slides were independently evaluated by three pathologists. Sixteen morphologic features were evaluated in the training set. Average absolute agreement, kappa scores, and association with malignancy were statistically evaluated. Recursive partitioning and multivariant analyses were performed on the features tested in the training set. Agreement data, univariate-odds ratios, and discriminatory power were calculated for the diagnostic features selected from the training set. The selected morphologic features formed a scoring rule that was then applied to the validation set. RESULTS: The average absolute agreement in the training set was 72%. Anisonucleosis, nuclear crowding, macro nucleoli, single atypical epithelial cells, and intracytoplasmic mucin showed the highest interrater reliability. Anisonucleosis, macronucleoli, single atypical epithelial cells, and intracytoplasmic mucin were most predictive of malignancy. A simple scoring rule was developed combining these morphologic features and applied to the validation set. Analysis of the area under the receiver operating characteristic (ROC) curve confirmed the statistical validity of the scoring rule. CONCLUSION: A scoring system utilizing the presence or absence of anisonucleosis, macronucleoli, single atypical epithelial cells, and mucinous metaplasia yielded good discriminatory power (area under ROC curve = 0.87).

6 Article Significance of the diagnostic categories "atypical" and "suspicious for malignancy" in the cytologic diagnosis of solid pancreatic masses. 2014

Layfield, Lester J / Schmidt, Robert L / Hirschowitz, Sharon L / Olson, Matthew T / Ali, Syed Z / Dodd, Leslie L. ·Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri. ·Diagn Cytopathol · Pubmed #24578254.

ABSTRACT: Endoscopic ultrasound guided (EUS) fine-needle aspiration (FNA) investigation of solid pancreatic lesions has been shown to have good sensitivity and specificity. Many lesions can be definitely classified as benign or malignant but some can only be cytologically classified as "atypical" or "suspicious for malignancy". Risk for malignancy in these indeterminate categories has not been well categorized. The cytology records of four University Medical centers were searched for all EUS guided FNAs of solid pancreatic lesions. All cases with a diagnosis of "atypical", or "suspicious for malignancy" were selected for analysis when histologic biopsy or over 18 months clinical follow-up was available. Two hundred and ninety-two cases with a diagnosis of "atypical" or "suspicious for malignancy" and adequate follow-up were obtained from the combined data of the four institutions. The percentage malignant for the categories "atypical" and "suspicious for malignancy" were 79.2 and 96.3%, respectively. If the category "atypical" was classified as benign and "suspicious for malignancy" was classified as malignant, the resulting positive predictive value was 96.3 (95% CI: 92.6-98.5) and the negative predictive value 20.8 (95% CI: 13.4-30.0). The categories of "atypical" and "suspicious for malignancy" stratify risk for malignancy in a fashion, which may aid in patient counseling and selection of follow-up protocols. Classification of "suspicious for malignancy" as malignant optimizes diagnostic sensitivity and specificity.

7 Article Malignancy risk associated with diagnostic categories defined by the Papanicolaou Society of Cytopathology pancreaticobiliary guidelines. 2014

Layfield, Lester J / Dodd, Leslie / Factor, Rachel / Schmidt, Robert L. ·Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri. ·Cancer Cytopathol · Pubmed #24339321.

ABSTRACT: BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the predominant method for obtaining a preoperative tissue diagnosis for pancreatic lesions suspicious for malignancy. The diagnostic sensitivity and specificity of EUS-FNA are well documented, but malignancy risk associated with the diagnostic categories proposed by the Papanicolaou Society of Cytopathology is poorly defined. METHODS: The records of the Departments of Pathology at Duke University and the University of Utah were searched for all cases of EUS-FNA performed for the investigation of pancreatic lesions. All cases with follow-up surgical diagnosis or greater than 3 years of clinical follow-up were selected. Cytologic diagnostic categories were "nondiagnostic," "benign," "atypical (not otherwise specified)," "suspicious for malignancy," "neoplasm," and "malignant." Correlation of cytologic diagnosis with surgical and/or clinical follow-up was made and risk of malignancy calculated for each category. RESULTS: Three hundred seventeen EUS-FNAs with adequate surgical or clinical follow-up were obtained. Risk of malignancy for nondiagnostic specimens was 21%;, benign specimens, 13%; atypical cases, 74%; suspicious for malignancy, 82%; the neoplasm category, 14%; and the malignant category, 97% CONCLUSIONS: The cytologic categories proposed by the Papanicolaou Society of Cytopathology demonstrate an increasing risk for malignancy extending from benign to malignant. Aspirates designated benign have the lowest risk of malignancy (13%) and aspirates designated malignant the highest (97%). The proposed categorization scheme stratifies risk for malignancy giving useful information to clinicians treating patients with pancreatic lesions.

8 Article Significance of atypia in pancreatic and bile duct brushings: follow-up analysis of the categories atypical and suspicious for malignancy. 2014

Chadwick, Barbara E / Layfield, Lester J / Witt, Benjamin L / Schmidt, Robert L / Cox, R N Kristin / Adler, Douglas G. ·Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah. ·Diagn Cytopathol · Pubmed #24167030.

ABSTRACT: Brushing cytology is frequently utilized for the investigation of pancreatic and biliary strictures but is associated with low diagnostic sensitivity. The Papanicolaou Society of Cytopathology has presented a system for diagnostic classification which includes the categories benign, atypical, suspicious for malignancy and malignant. We studied a series of 216 pancreatic and biliary brushings with either histologic follow-up or a minimum of 6 months clinical follow-up to determine outcomes for the diagnostic categories ("benign," "atypical, favor reactive," "atypical, not otherwise specified," "atypical, suspicious" and "malignant"). Eighty-six of the 216 (39.8%) were designated "atypical" with 10 of these designated as "atypical favor reactive." Forty-five were called "atypical not otherwise specified" and 31 were interpreted as "atypical suspicious for malignancy." On follow-up, 2 of 10 (20%) "atypical favor reactive" were eventually associated with a malignant diagnosis and 23 of 31 (74.2%) "atypical, suspicious for malignancy" demonstrated a malignant outcome. The remaining 45 brushings in the "atypical" category were "atypical not otherwise specified," and 62% of these were associated with malignancy on follow-up. Stratification of the "atypical" category into "atypical favor reactive," "atypical, not otherwise specified" and "atypical, suspicious for malignancy" improves diagnostic accuracy. The "atypical suspicious for malignancy" category has a follow-up similar to the "malignant" category while the "atypical favor reactive" category is associated with a clinical outcome similar to that of the "benign" category.

9 Article Rapid on-site evaluation reduces needle passes in endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: a risk-benefit analysis. 2013

Schmidt, Robert L / Walker, Brandon S / Howard, Kirsten / Layfield, Lester J / Adler, Douglas G. ·Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA. ·Dig Dis Sci · Pubmed #23824404.

ABSTRACT: BACKGROUND: The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized. AIMS: The purpose of this study was to compare the risk-benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE). PATIENTS AND METHODS: We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy rates. RESULTS: Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE. CONCLUSIONS: Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes.

10 Article A comparative needle study: EUS-FNA procedures using the HD ProCore(™) and EchoTip(®) 22-gauge needle types. 2013

Witt, Benjamin L / Adler, Douglas G / Hilden, Kristen / Layfield, Lester J. ·Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah. ·Diagn Cytopathol · Pubmed #23513000.

ABSTRACT: The specific needle sizes/types used in performing endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) vary. The HD ProCore(™) is a 22-gauge beveled needle allowing for core biopsy along with aspiration material. In this study we compare this needle with a standard 22-gauge needle. Between April 1, 2011 and November 15, 2011, 18 patients undergoing EUS-FNA using the HD ProCore(™) needle were compared to a control group of 18 cases using the standard 22-gauge needle. Smears were assessed for: three-dimensional clusters, thick obscuring clusters, monolayer sheets, cellularity, crowded obscuring single cells, blood, and nuclear staining. Cell blocks were assessed for cellularity and presence of diagnostic material. Records were reviewed for the overall adequacy, number of FNA passes, and patient follow-up. Overall, the two needle groups demonstrated similar results for the cytology parameters, amount of diagnostic cell block material, adequacy, and accuracy. The mean number of passes to achieve adequacy varied between the groups [2.94 for the standard 22-gauge needle group versus 2.11 for the beveled needle group (P=0.03)] with no meaningful difference in case duration between needle groups. No complications were reported. The beveled EUS needle affords similar cytologic interpretability, adequacy, diagnostic accuracy, and amount of cell block material as a standard needle. There was a statistically significant trend toward fewer passes to achieve adequacy with the beveled EUS-FNA needle. Therefore, the EUS-FNA needle with a lateral bevel is a diagnostically similar alternative to standard endoscopy needles, the possibility that this beveled needle may improve per pass adequacy requires further verification.

11 Article Identification of factors predictive of malignancy in patients with atypical biliary brushing results obtained via ERCP. 2013

Witt, Benjamin L / Kristen Hilden, R N / Scaife, Courtney / Chadwick, Barbara / Layfield, Lester / Cory Johnston, W / Safaee, Maryam / Siddiqui, Ali / Adler, Douglas G. ·Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. ·Diagn Cytopathol · Pubmed #23008113.

ABSTRACT: Biliary brushings obtained during ERCP can have one of three cellular interpretations: benign, malignant, or "atypical." Atypical interpretations usually result in further testing, and may cause controversy over management and increases in cost. We evaluated a large cohort of patients with atypical biliary brushings for analysis and risk stratification. All biliary brushing specimens collected between January 1, 2001 and December 31, 2010 that had an atypical result were included. Hospital electronic records were reviewed for these patients to include: demographics, indication for ERCP, endoscopist/pathologist impressions, serologic testing, stricture site, and information relating to the final clinical diagnosis. Eighty-six patients were included. Totally, 60/86 patients (70%) had malignancies while 26/86 (30%) had no evidence of malignancy during long term follow up. Univariate analysis showed that the risk of malignant outcomes was significantly associated with older age, suspicious/malignant endoscopic impression, pancreatic mass, indications including jaundice and/or dilated bile ducts, stricture location within the common bile duct, PSC, and CA 19-9 levels >300 U/mL. We created a novel scoring system for prediction of malignancy based on clinical and endoscopic factors. We identified parameters that are typically available to the clinician to categorize patients with an "atypical" bile duct brushing results into "high risk" and "lower risk" classifications. Our proposed scoring system would allow such risk stratification to take place.

12 Article Metastatic disease to the pancreas documented by endoscopic ultrasound guided fine-needle aspiration: a seven-year experience. 2012

Layfield, Lester J / Hirschowitz, Sharon L / Adler, Douglas G. ·Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah 84112, USA. layfiel@aruplab.com ·Diagn Cytopathol · Pubmed #22334524.

ABSTRACT: The study was performed to determine the frequency and origin for metastatic disease to the pancreas as found in an endoscopic ultrasound directed fine-needle aspiration series. The records of the Departments of Pathology at the University of Utah School of Medicine and the David Geffen School of Medicine were electronically searched for all fine-needle aspirates obtained from pancreatic masses between January 1, 2002 and March 31, 2010. All cases with a diagnosis of metastatic disease were reviewed and whenever possible correlated with subsequent resection specimens. A total of 17 metastatic malignancies to the pancreas were detected in pancreatic FNAs representing 0.73% of all cases. Primaries included eight renal cell carcinomas, one medullary carcinoma of the thyroid, four lymphomas, one alveolar rhabdomyosarcoma, one squamous cell carcinoma derived from the esophagus, and a second squamous cell carcinoma originating from a lung primary and a small cell carcinoma of the lung. Metastatic renal cell carcinoma was the most frequent metastasis to the pancreas representing 47% of metastatic lesions detected by FNA. The metastatic deposits could be detected in the pancreas as many as 10 years following the original diagnosis and resection of the renal cell carcinoma.

13 Article Cytologic features of pancreatic intraepithelial neoplasia and pancreatitis: potential pitfalls in the diagnosis of pancreatic ductal carcinoma. 2011

Jarboe, Elke A / Layfield, Lester J. ·Division of Anatomic Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, UT 84110, USA. ·Diagn Cytopathol · Pubmed #20730891.

ABSTRACT: Fine-needle aspiration (FNA) has played a significant role in the diagnosis of pancreatic masses but false-positive diagnoses occur. The Anatomic Pathology files were searched for FNAs of pancreas with subsequent resections. FNAs with a diagnosis of positive for or suspicious for adenocarcinoma followed by a benign resection specimen were reviewed and the surgical pathology and cytology findings correlated. Six cases had a cytologic diagnosis of adenocarcinoma or suspicious for adenocarcinoma but resection specimens were benign. In two cases, a non-invasive intraductal papillary mucinous neoplasm (IPMN) without significant dysplasia was present surrounded by foci of pancreatic intraepithelial neoplasia (PanIN). In both cases, the degree of atypia within the IPMN was less than that seen cytologically. The nuclear features of the PanIN overlapped those seen in the smears. In two cases, a neuroendocrine neoplasm was present accompanied by multifocal PanIN. The cytologic features of the neuroendocrine neoplasm did not correlate with the material cytologically diagnosed as adenocarcinoma. The cytologically atypical epithelium was similar to the PanIN. Two diagnoses of adenocarcinoma were made cytologically but the pancreatectomy specimens revealed pancreatitis with reactive atypia. Cytologic diagnosis of pancreatic adenocarcinoma has high specificity. Six cytologic misdiagnoses of adenocarcinoma occurred in 105 patients. The cytologic features of these misdiagnoses correlated with histopathologic changes of intermediate to high-grade PanIN or marked reactive atypia in severe pancreatitis. PanIN may be an under recognized, but significant source of false-positive results.

14 Article Medical image. A case of recurrent hypoglycaemia. Insulinoma. 2010

Swendsen, Scott / Layfield, Lester / Adler, Douglas G. ·University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA. ·N Z Med J · Pubmed #20720610.

ABSTRACT: -- No abstract --

15 Article Metastatic pancreatic adenocarcinoma presenting as a large pelvic mass mimicking primary osteogenic sarcoma: a series of two patient cases. 2010

Webber, Nicholas P / Sharma, Sunil / Grossmann, Allie H / Shaaban, Akram / Jones, Kevin B / Layfield, Lester J / Randall, R Lor. ·Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. ·J Clin Oncol · Pubmed #20713877.

ABSTRACT: -- No abstract --