Next-generation sequencing of pancreatic cyst wall specimens obtained using micro-forceps for improving diagnostic accuracy

Background and study aims Pancreatic cysts are common incidental findings, with an estimated prevalence of 13% to 15% in imaging done for other reasons. Diagnosis often relies on collection of cyst fluid, but tissue sampling using micro-forceps may allow for a more reliable diagnosis and higher yield of DNA for next-generation sequencing (NGS). The primary aim was to assess the performance of NGS in identifying mucinous cyst. The secondary aims were to assess DNA yield between the cyst fluid and cyst wall tissue, complication rate and performance of conventional investigations. Patients and methods Twenty-four patients referred for endoscopic ultrasound were recruited. Biopsies were taken using micro-forceps and the AmpliSeq Cancer Hotspot panel was used for NGS, a polymerase chain reaction assay targeting several hotspots within 50 genes, including GNAS , KRAS and VHL . Results The concentration of DNA extracted from 24 cyst wall samples was significantly higher than in the nine of 24 available matched cyst fluid samples. The sensitivity, specificity, and diagnostic accuracy of NGS for diagnosing mucinous cyst were 93%, 50% and 84%; for standard of care, they were -66.6%, 50% and 63.1%; and for standard of care with NGS, they were 100%, 50%, and 89.4% respectively. Cyst wall biopsy was able to diagnose 19 of 24 cysts (4 high risk, 7 intraductal papillary mucinous neoplasms, 4 cysts of mucinous origin, and 4 benign). Conclusions NGS data correlate well with histology and may aid in diagnosis and risk stratification of pancreatic cysts. Cyst wall biopsy performs well in diagnosing cysts but was inadequate in five of 24 patients.

Student-led approaches to mental health support

Mental health issues amongst university students are rife. Increasing mental health literacy and an emphasis on wellbeing have revealed the importance of having a plethora of resources available to students surrounding mental health support. The Welfare Hub is a student-led project created at the University of Nottingham Medical School to destigmatise mental health discussion, enhance mental health education, and share experiences of healthcare professionals regarding their mental health and university support. In this paper, we incorporate discussion around improvements the Welfare Hub can make regarding its content and how to best support future students. This project identified that the Welfare Hub's Instagram account was closely associated with mental health awareness and education, and that the best performing posts were those that offered positive connotations of support relevant to medical students and those that detailed lived medical student's experiences and advice. The Welfare Hub has had a positive impact on committee members and allowed them to fulfil their desires regarding destigmatising and discussing mental health. Future development following these findings aim to produce more educational and supportive content, develop connections of the Welfare Hub within the University and other institutions, and host events for the well-being of medical students.