Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis

Waaij, Laurens A. van der; Dullemen, Hendrik M. van; Porte, Robert J.

doi:10.1016/s0016-5107(05)01581-6

Cited by 542 publications

(387 citation statements)

References 18 publications

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“…17,18 If squamous epithelium, keratin debris and lymphocytes are seen in the absence of worrisome features, a diagnosis of lymphoepithelial cyst can be made. In our series of lymphoepithelial cyst, only four cases (44%) had squamous cells or squamous debris and only one case (11%) had lymphocytes.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

et al. 2010

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Pancreatic lymphoepithelial cysts are rare benign cysts that cannot be reliably differentiated from neoplastic mucinous cysts preoperatively. Although elevated cyst fluid carcinoembryonic antigen (CEA) levels support a diagnosis of a mucinous cyst, the finding of increased CEA levels in lymphoepithelial cysts prompted this study. Nine resected lymphoepithelial cysts were examined for expression of CEA, carbohydrate antigen (CA) 19-9, CK7, p63, PAS-D and a panel of mucins. The pathology data were correlated with clinical information, including serum, cyst fluid and imaging studies. By computed tomography scan, although most lymphoepithelial cysts appeared cystic, 23% were described as masses. The endoscopic ultrasound findings were variable, but the lymphoepithelial cysts tended to be hypoechoic cystic lesions or masses. On cytology, 44% of the cysts had squamous cells, 67% had glandular cells and 56% had atypical cells. The cysts were resected because of size Z3 cm (89%), symptoms (44%) and/or elevated cyst fluid CEA levels (33%). The cyst fluid CEA levels in the three cysts tested were 4450 ng/ml. Histopathologically, all cysts were lined by mature, stratified squamous-type cells and produced keratin. Mucous cells were present in 78% of the cysts. The immunohistochemical profile of the squamous lining was CK7 þ , p63 þ , MUC1 þ , MUC4 þ , MUC2À, MUC5ACÀ and MUC6À. Even though lymphoepithelial cysts are lined by squamous-type epithelium, all our resected lymphoepithelial cysts expressed CEA and/or CA19-9, many contained mucous cells, and three exhibited markedly elevated cyst fluid CEA levels. Although cyst fluid CEA levels 4200 ng/ml support the diagnosis of mucinous neoplasms, this study emphasizes the need for clinicians and pathologists to recognize that lymphoepithelial cysts can mimic neoplastic mucinous cysts clinically, radiographically and on cyst fluid CEA analysis.

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Section: Discussionmentioning

confidence: 99%

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

et al. 2010

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“…17 A low CEA of <5 ng/mL has a 50 % sensitivity and 95 % specificity for the identification of a SCA or pseudocyst. 18 Cyst fluid amylase is elevated if there is communication between the cyst and the main pancreatic duct with a very low amylase (<250 IU/L) associated with a 98 % specificity for pseudocyst. In a large, prospective multicenter trial, cytology had a high specificity (83 %) but low sensitivity (35 %) for identifying mucinous cysts.…”

Section: Diagnosismentioning

confidence: 99%

Cystic Neoplasms of the Pancreas

Lennon

Wolfgang

2013

Journal of Gastrointestinal Surgery

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Pancreatic cysts are being identified with increasing frequency due to a combination of increased awareness and more frequent use of cross sectional imaging. Cystic neoplasms of the pancreas range from completely benign to frankly malignant. Identifying pre-malignant cysts offers the opportunity to prevent the development of pancreatic cancer. This article reviews the presentation, workup, and non-operative and operative management of premalignant and malignant pancreatic cysts.

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“…1a) and described as a possible side-branch IPMN. EUS-FNA cyst fluid resulted in a CEA of 686 ng/ml, significantly higher than the 192 ng/ml cut-off suggestive of a mucinous lesion 6,25 . Cytology reported scant acellular debris which could not be further categorized.…”

Section: Resultsmentioning

confidence: 70%

Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

et al. 2017

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Pancreatic cancers are usually detected at an advanced stage and have poor prognosis. About one fifth of these arise from pancreatic cystic lesions. Yet not all lesions are precancerous, and imaging tools lack adequate accuracy for distinguishing precancerous from benign cysts. Therefore, decisions on surgical resection usually rely on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unfortunately, cyst fluid often contains few cells, and fluid chemical analysis lacks accuracy, resulting in dire consequences, including unnecessary pancreatic surgery for benign cysts and the development of cancer. Here, we report an optical spectroscopic technique, based on a spatial gating fibre-optic probe, that predicts the malignant potential of pancreatic cystic lesions during routine diagnostic EUS-FNA procedures. In a double-blind prospective study in 25 patients, with 14 cysts measured in vivo and 13 postoperatively, the technique achieved an overall accuracy of 95%, with a 95%confidence interval of 78–99%, in cysts with definitive diagnosis.

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Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis

Cited by 542 publications

References 18 publications

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

Cystic Neoplasms of the Pancreas

Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

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