Pathology

Cyst-fluid NGS HRM panel strongly predicts advanced neoplasia in mixed-type IPMN

In 674 IPMN patients, mixed-type lesions showed substantially higher rates of high-risk mutations (TP53, SMAD4, CTNNB1, MTOR) than branch-duct IPMN. Mixed-type IPMN were independently associated with high-risk mutations on multivariable analysis (odds ratio 3.42; 95% CI, 1.72–6.82). Preoperative cyst-fluid NGS detection of any high-risk mutation predicted advanced neoplasia in mixed-type IPMN with 90% sensitivity and 100% specificity. Imaging-based worrisome features or high-risk stigmata were highly sensitive but had very poor specificity for advanced neoplasia. 1

MTAP and S100P IHC panel improves PDAC diagnosis in EUS-FNAB samples

This study evaluated MTAP and S100P immunohistochemistry in 27 EUS-FNAB pancreatic masses, correlating MTAP loss with CDKN2A alterations. About 25% of FNAB-diagnosed PDACs showed complete loss of MTAP expression, giving 100% positive predictive value but modest sensitivity (31.5%). S100P was positive in 71% of PDAC cases, while the single benign case was S100P negative, supporting its utility as a malignancy marker. Combining MTAP and S100P increased sensitivity to 75% while maintaining 100% specificity for PDAC diagnosis on FNAB material. 2

Tumor budding and cell nest size on H&E biopsies predict cervical cancer survival

In 182 FIGO 2018 stage I–IIA cervical cancers, pretreatment biopsy tumor budding and cell nest size independently predicted overall survival. Multivariable analysis showed tumor budding (HR 2.06) and small cell nest size (HR 2.16) as adverse prognostic factors. Tumor budding alone (AUC 0.7065) slightly outperformed cell nest size (AUC 0.6975) for survival discrimination. Combining tumor budding and cell nest size yielded the best performance (AUC 0.7192) in time-dependent ROC analyses. 3