Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study

Jong, Koen de; Poley, Jan–Werner; Hooft, Jeanin E. van; Visser, Mike; Bruno, Marco J.; Fockens, Paul

doi:10.1055/s-0030-1256440

Cited by 134 publications

(105 citation statements)

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“…Turk J Gastroenterol 2014; 25: 1-18 malignancy is around 25% (from 8% to 29-36%) (27,45,47,48). Cytological yield is poor with EUS-FNA: Cytology was positive in only 29% of malignant mucinous tumours.…”

Section: şEntürk H Management Of Cystic Diseases Of the Pancreasmentioning

confidence: 99%

“…The cytologic yield of EUS-FNA is rather poor: The overall accuracy of EUS-FNA cytology was reported as 50% (24)(25)(26). Interim analysis of a recent study demonstrated that the rate of sufficient material is 49 % for fluid analysis and, 31% for cytology (27). However the yield may be increased with some special techniques as puncturing the wall at the expense of increased risk of pancreatitis (28).…”

Section: Eus: Diagnostic Performancementioning

confidence: 99%

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Management of cystic diseases of the pancreas

Şentürk

2014

Turk J Gastroenterol

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Pancreatic cysts are challenging to the gastroenterologist. Detection rate is increasing and neither criteria for a definitive diagnosis, nor a validated surveillance strategy is available. Pancreatic endosonography with or without sampling is necessary in most of the cases. However this technique requires expertise and is not widely available. While some cysts have a malignant potential or already malign at the diagnosis, most are benign and remain so for decades. We are going to review the existing data on this controversial subject.

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Section: şEntürk H Management Of Cystic Diseases Of the Pancreasmentioning

confidence: 99%

Section: Eus: Diagnostic Performancementioning

confidence: 99%

Management of cystic diseases of the pancreas

Şentürk

2014

Turk J Gastroenterol

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“…Several recent studies demonstrate that even with the use of fine needle aspiration (FNA) during endoscopic ultrasound, the accuracy of the preoperative diagnostic work-up does not significantly increase [11] . The sensitivity of FNA cytology is around 38% [12] , while combined biochemistry and cytology provides a correct diagnosis in only 33% [13,14] . For this reason, there is a concrete danger of over-or underestimation of the risk of malignant transformation in some lesions and, as a consequence, of over-or undertreatment of the patients.…”

Section: Editorialmentioning

confidence: 99%

Cystic tumors of the pancreas: Opportunities and risks

Chiaro

Verbeke

2015

WJGP

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neoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new "era" of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e. , the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under-or over-treatment of patients and incur high costs for the Health Care System. Core tip: The present paper is an editorial focused on the critical problems regarding the management strategy of pancreatic cystic neoplasms (PCNs). Being a pre-cancerous condition in most of the cases, PCNs represent a unique opportunity to prevent pancreatic cancer and to develop preemptive pancreatic surgery programs. However, the lack of predictive factors of the behaviour of these lesions, the low accuracy of AbstractPancreatic cystic neoplasms (PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinous 29May 15, 2015|Volume 6|Issue 2|

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“…Although biochemical markers such as carcinogenic embryonic antigen (CEA) and amylase measured in cyst fluid aspirates are frequently used to aid in diagnosis of pancreatic cysts, the authors focused on cytologic yield from EUS-FNA. In the literature, the overall yield of EUS-FNA for cytologic analysis of indeterminate pancreatic cystic lesions is 31-37 % [2,4].Morphologic features noted by high resolution EUS images of small pancreatic cysts can help differentiate mucinous-type cysts from others. Nevertheless, in a recent study, expert endosonographers were evaluated for their ability to make a diagnosis of pancreatic MCN based on EUS appearance alone without FNA.…”

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confidence: 99%

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EUS for Pancreas Cysts: What Should We Be Sampling?

Sreenarasimhaiah

2013

Dig Dis Sci

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The growing resolution and more frequent use of imaging methods has increasingly identified pancreatic cysts, ranging from benign serous and pseudocysts to premalignant or malignant mucinous cystic neoplasm (MCN). Due to the disparate course and management of benign cysts versus cystic neoplasms or pre-neoplasms, unambiguous lesion identification is essential, which is not always possible with conventional cross-sectional imaging [1]. Thus, an increasing number of centers are utilizing endoscopic ultrasound (EUS) for further characterization of pancreatic cysts with high resolution images of cyst morphology, size, presence and type of septations, presence of solid components, and the ability to sample cyst contents using fine needle aspiration (FNA) and to perform biopsies. Characteristics such as diameter [3 cm and the presence of mural nodules may be the best predictors of malignant transformation of MCN or side-branch type intraductal papillary neoplasms (SB-IPMN) [2]. In some cases, however, biopsy of solid material or aspiration of cyst fluid is essential to confirm the diagnosis. Thus, when a pancreas cyst is detected on CT or MRI, the clinical question often arises as to whether EUS should be performed and, furthermore, if additional FNA or biopsy is helpful.In this month's issue of Digestive Diseases and Sciences, Lim et al. [3] report their findings in ''Factors determining diagnostic yield of EUS guided fine-needle aspiration for pancreatic cystic lesions: a multicenter Asian study.'' The authors include a multicenter analysis of 298 patients with diverse pancreatic cystic lesions who underwent EUS of whom 132 (44 %) underwent EUS-FNA.FNA cytology with a single pass was only 29 % when solid components are not present. Furthermore, their study demonstrated a higher yield (44 %) when solid components were biopsied during a single pass, which increased to 78 % with multiple passes. Although biochemical markers such as carcinogenic embryonic antigen (CEA) and amylase measured in cyst fluid aspirates are frequently used to aid in diagnosis of pancreatic cysts, the authors focused on cytologic yield from EUS-FNA. In the literature, the overall yield of EUS-FNA for cytologic analysis of indeterminate pancreatic cystic lesions is 31-37 % [2,4].Morphologic features noted by high resolution EUS images of small pancreatic cysts can help differentiate mucinous-type cysts from others. Nevertheless, in a recent study, expert endosonographers were evaluated for their ability to make a diagnosis of pancreatic MCN based on EUS appearance alone without FNA. The accuracy was only 23-46 % despite the use septations, mural nodules, solid components, and communication with the pancreatic duct as criteria [5]. Therefore, FNA for fluid analysis or biopsy of solid materials may add to diagnostic yield, particularly for indeterminate cysts. Solid material within a cyst may represent debris but could also arise from malignancy.Several studies have addressed the acquisition of pancreatic cyst specimens and types of analysis that ...

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Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study

Abstract: Although EUS-guided FNA was technically feasible in the majority of patients with pancreatic cystic lesions (87 %), it was possible to obtain a classifying cytopathologic diagnosis and a chemical analysis in only a third and a half of cases, respectively.

Cited by 134 publications

References 19 publications

Management of cystic diseases of the pancreas

Management of cystic diseases of the pancreas

Cystic tumors of the pancreas: Opportunities and risks

EUS for Pancreas Cysts: What Should We Be Sampling?

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