Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study

Nakai, Yousuke; Iwashita, Takuji; Park, Do Hyun; Samarasena, Jason; Lee, John G.; Chang, Kenneth J.

doi:10.1016/j.gie.2014.10.025

Cited by 159 publications

(142 citation statements)

References 23 publications

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“…The reason for these spurious fluctuating CEA levels is not entirely clear. However, we noticed variability of simultaneous CEA levels taken from different cysts within the same pancreas, possibly because the mucin concentration may vary (clumping) within the same cyst as seen routinely during EUS-guided cystoscopy by using through-the-needle fiber optic imaging 19 (described as “mucin clouds”). It is quite possible that the more highly concentrated mucin clumps may yield higher CEA levels.…”

Section: Discussionmentioning

confidence: 94%

Role of serial EUS-guided FNA on pancreatic cystic neoplasms: a retrospective analysis of repeat carcinoembryonic antigen measurements

Nakai

Iwashita

Shinoura

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Pancreatic cystic neoplasms (PCNs) often need interval surveillance, including repeat EUS, but the role of repeat FNA with fluid analysis is poorly defined. The aim of this analysis is to evaluate the potential clinical significance of serial carcinoembryonic antigen (CEA) measurements by EUS-guided FNA (EUS-FNA) in the surveillance for PCNs. Patients Patients who underwent EUS-FNA for PCNs were studied retrospectively. EUS-FNA findings were compared between index and prior procedures among patients who underwent repeat EUS-FNA. Results A total of 400 patients with PCNs underwent EUS-FNA. Eighty-seven of those patients had prior EUS-FNA with cyst fluid analysis. Patients with repeat FNA were significantly more likely to have multiple cysts (57% vs 41%; P = .008), multilocular cysts (75% vs 62%; P = .042), connection to pancreatic duct (33% vs 18%; P = .005), and higher initial CEA levels (94.8 vs 25.6 ng/mL; P = .003) compared with patients who had only a single FNA. A comparison of prior and index FNAs did not show significant differences in EUS or cyst fluid analysis findings. After log transformation, the association between CEA level at prior and index FNA was moderate (R2 = 0.626; P < .001), but cystic fluid CEA classification with a cutoff value of 192 ng/mL changed in 17 patients (20%), without significant changes in EUS findings. Conclusions Repeat surveillance EUS-FNA resulted in stable CEA levels in the majority of patients, with spurious fluctuations of CEA in approximately 20% of patients. These data call into question any clinical significance attributed to an isolated interval rise in CEA level, especially in light of a stable EUS examination.

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Section: Discussionmentioning

confidence: 94%

Role of serial EUS-guided FNA on pancreatic cystic neoplasms: a retrospective analysis of repeat carcinoembryonic antigen measurements

Nakai

Iwashita

Shinoura

et al. 2016

Gastrointestinal Endoscopy

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“…Lastly, several studies have demonstrated an increased efficacy of EUS if combined with through-the-needle confocal laser-induced endomicroscopy. In fact, a recent study (74) showed a diagnostic accuracy of 93% when discriminating mucinous cysts if cystoscopy was also added to this technique. Moreover, the results showed a superior diagnostic accuracy if both techniques were performed combined versus independently (87% laser-induced endomicroscopy and 83% cystcoscopy, respectively).…”

Section: Endoscopic Modalitiesmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

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“…In a pilot study, sensitivity and specificity of endomicroscopic findings were 69 and 100 % for differentiating mucinous cysts from SCA and pseudocysts [85]. Pancreatitis occurred in 3 % [86]. The feasibility of performing both needle confocal endomicroscopy and cystoscopy using the SpyGlass fiberoptic probe in pancreatic cysts was demonstrated although the rate of pancreatitis was 7%.…”

Section: What Does the Future Hold?mentioning

confidence: 93%

EUS in Pancreatic Cysts

Lee

2015

ERCP and EUS

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Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study

Cited by 159 publications

References 23 publications

Role of serial EUS-guided FNA on pancreatic cystic neoplasms: a retrospective analysis of repeat carcinoembryonic antigen measurements

Role of serial EUS-guided FNA on pancreatic cystic neoplasms: a retrospective analysis of repeat carcinoembryonic antigen measurements

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

EUS in Pancreatic Cysts

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