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Conference Proceeding

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Archives of Pathology & Laboratory Medicine


Context: SMAD4 and IMP3 are useful stains in diagnosing pancreatic cancer but not perfect to reach that goal individually. We attempted to determine if using both SMAD4 and IMP3 can increase the diagnostic specificity of fine-needle biopsies (FNBs) for pancreatic adenocarcinomas, as FNBs often showed limited tissue for the morphologic evaluation.

Design: Fifteen FNBs with or without prior cytology were evaluated with both SMAD4 and IMP3 stains. Nuclear loss of SMAD4 was graded as 0 (no loss), 1–2+ (partial loss), and 3+ (total loss), whereas IMP3 was graded 0–3+ by staining intensity. Staining results were correlated with morphologic changes for final diagnoses of pancreatic adenocarcinoma.

Results: Total loss of SMAD4 and positive IMP3 staining confirmed 53% (8/15) of pancreatic tumors (Table). Partial loss (1+ to 2+) of nuclear staining for SMAD4 with positive IMP3 staining was seen in 27% (4/15) of pancreatic tumors. IMP3 was positive in most pancreatic cancer cases (13/15, 87%), except 2 cases where the foamy variant of poorly differentiated pancreatic ductal carcinoma was seen. Combined IMP3 positivity and total/partial loss of SMAD4 were seen in 93% (14/15) of cases of pancreatic adenocarcinoma diagnosed on FNB sections, except case 4 (negative IMP3 and partial loss of SMAD4).

Conclusions: Our data suggest that a combination of both SMAD4 and IMP3 showed increased power to confirm the morphologic suspicion of pancreatic adenocarcinoma by FNB.





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College of American Pathologists 2023 Annual Meeting CAP23, October 7-10, 2023, Chicago, IL

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