Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study

Brugge, William R.; Lewandrowski, Kent; Lee-Lewandrowski, Elizabeth; Centeno, Barbara A.; Szydlo, Tara; Regan, Susan; Castillo, Carlos Fernández del; Warshaw, Andrew L.

doi:10.1053/j.gastro.2004.02.013

Cited by 1,277 publications

(1,091 citation statements)

References 28 publications

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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: 71%

“…Recently, a large multicenter prospective clinical study evaluated both cytology and CEA for their ability to diagnose mucinous cystic lesions based on EUS-FNA in 341 patients. Pancreatic surgical resections of 112 of these patients found that cytology of cyst fluid has a sensitivity of 35% and a specificity of 83% for diagnosing mucinous vs. non-mucinous cysts and just 22% sensitivity for detecting mucinous cystic cancers 6 . Apart from CEA, the diagnostic potential of other molecular markers including amylase 40 , cancer antigen (CA) 19-9 41,42 , DNA 43 , and fluid viscosity 44 have been investigated, with CEA being the only marker that achieves enough accuracy to be of clinical utility.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the recent improvements in CT and MRI methodologies, these imaging approaches are unable to distinguish cancerous, premalignant and benign cysts reliably, in part due to a lack of sensitivity to cellular structure and biochemical properties, with wide variations in the reported accuracy ranging from 20% to 80% 37 . EUS is still the most sensitive technique currently available for the detection of small (<2–3 cm) pancreatic cysts 38,39 , however, the accuracy of EUS for distinguishing mucinous from non-mucinous cysts is only 51% 6 . Because imaging techniques have a limited ability of identifying the type of pancreatic cyst, there has been a major effort to identify the cyst type with cyst fluid obtained during EUS-FNA procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from CEA, the diagnostic potential of other molecular markers including amylase 40 , cancer antigen (CA) 19-9 41,42 , DNA 43 , and fluid viscosity 44 have been investigated, with CEA being the only marker that achieves enough accuracy to be of clinical utility. However, CEA addition provides only a slight improvement over cytology alone in distinguishing between benign and mucinous cysts 6 . Due to the limited performance of existing cytological and molecular markers, a strong need is present to augment existing cyst fluid analysis approaches with an accurate diagnostic test.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure has an overall sensitivity of less than 50% for detecting malignancy with the majority of results being non-diagnostic 6,7 . During the EUS-FNA procedure the cyst fluid is collected and then analyzed both for tissue (cytopathology) evaluation, and also for the presence of certain molecular markers or glycoproteins, such as carcinoembryonic antigen (CEA).…”

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confidence: 99%

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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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Section: Resultsmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2017

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Cystic Pancreatic Neoplasm in Pregnancy

Wiseman

Yamamoto²,

Nguyen³

et al. 2008

Arch Surg

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Mucinous cystic neoplasms of the pancreas are rare tumors that tend to occur in young women. They are thought to be responsive to sex hormones. We report a case of a 32-year-old pregnant woman with a 7-month history of pain and a left upper quadrant abdominal mass. She arrived at the emergency department with exacerbation of her symptoms during week 15 of gestation. Findings from ultrasonography and magnetic resonance imaging suggested a pancreatic cyst. Percutaneous aspiration of the cyst fluid yielded mucinous fluid with an elevated carcinoembryonic antigen level. The patient underwent a spleen-preserving distal open pancreatectomy. We present herein a brief review of the current literature on mucinous cystic neoplasms during pregnancy. On the basis of our experience and the existing knowledge of this condition, we advocate resection during the second trimester with splenic preservation.

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Treatment Strategy for Intraductal Papillary Mucinous Neoplasm of the Pancreas Based on Malignant Predictive Factors—Invited Critique

Adams¹

2009

Arch Surg

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Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study

Cited by 1,277 publications

References 28 publications

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

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

Cystic Pancreatic Neoplasm in Pregnancy

Treatment Strategy for Intraductal Papillary Mucinous Neoplasm of the Pancreas Based on Malignant Predictive Factors—Invited Critique

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