Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions

Okasha, Hussein Hassan; Behiry, Mervat Essam; Ramadan, Nagwa; Ezzat, Reem; Yamany, Ahmed; El-Kholi, Shaimaa; Ahmed, Ghada H.

doi:10.1016/j.ajg.2019.05.008

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…Also, positive mucin staining was 63% sensitive and 97% specific in differentiating malignant/potentially malignant from benign pancreatic cysts with a PPV of 96%, NPV of 72%, and overall accuracy of 80%. This outcome is in concordance with a recent study by Okasha and his colleagues that showed that a CF positive mucin stain has a sensitivity of 85.5% and specificity of 86.1% for detecting mucinous cystic neoplasm with a 72.3% PPV, 93.3% NPV, and 85.9% accuracy[ 4 ]. Many studies also reported that the mucin staining could be complementary to cyst CEA levels and cytology, and when one out of three was found to be positive, this increases the sensitivity to 92% and specificity to 52%, as in a study conducted by Morris-Stiff et a l[ 22 ].…”

Section: Discussionsupporting

confidence: 91%

“…Awareness of these lesions has increased in recent years, especially with the increased incidence of asymptomatic pancreatic cysts in the general population primarily due to improved detection by different advanced imaging modalities[ 2 , 3 ]. Therefore, the proper diagnosis, meticulous differentiation, and staging of these PCLs are crucial for proper management and avoiding unnecessary treatment of benign lesions and missing early treatment of the malignant/pre-malignant lesions[ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The morphological features of PCLs are not independent factors in differentiating malignant from nonmalignant lesions. The combination of both EUS-fine needle aspiration (EUS-FNA) ﬁndings with cystic ﬂuid tumor marker analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics, enhances the diagnostic accuracy for PCLs and helps to construct a novel model in the era of PCL diagnosis[ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

Okasha¹,

Abdellatef²,

Elkholy³

et al. 2022

WJGE

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BACKGROUND Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM To evaluate the role of cyst ﬂuid analysis of different tumor markers such as cancer antigens [ e.g. , cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively ( P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance ( P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

Okasha¹,

Abdellatef²,

Elkholy³

et al. 2022

WJGE

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“…Mucin staining, carcinoembryonic antigen (CEA), CA19-9, and amylase levels in the cystic fluid improve the diagnosis of pancreatic cysts[ 20 - 22 ]. A study carried out by Okasha et al [ 10 ] shows that the highest AUC was that of cystic CEA, with a cutoff value of 160 ng/mL, and that it had a sensitivity of 60.4% and a specificity of 85%. It also mentioned that the best cutoff value for cystic CA19-9 was 1318 U/mL with a sensitivity of 64.1% and a specificity of 68.1%.…”

Section: Cystic Lesions Of the Pancreas: Types Diagnosismentioning

confidence: 99%

“…The combination of both EUS-FNA ﬁndings with cystic ﬂuid tumor markers analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics, enhances the diagnostic accuracy of PCLs and helps to construct a novel model in the era of cystic pancreatic lesion diagnosis[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Cystic pancreatic lesions, the endless dilemma

Okasha¹,

Awad²,

Elmeligui³

et al. 2021

WJG

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Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions. The proper diagnosis, differentiation, and staging of these cystic lesions are considered a crucial issue in planning further management. There are great challenges for their diagnostic models. In our time, new emerging methods for this diagnosis have been discovered. Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needle-based confocal laser endomicroscopy, through the needle microforceps biopsy, and single-operator cholangioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions. Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.

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Pancreatic intra-cystic CA 19-9 dosage in the management of pancreatic cysts: Useful or confounding?

Stigliano

Zaccari

Severi

2021

Digestive and Liver Disease

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Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions

Cited by 7 publications

References 21 publications

Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

Cystic pancreatic lesions, the endless dilemma

Pancreatic intra-cystic CA 19-9 dosage in the management of pancreatic cysts: Useful or confounding?

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