Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability

Kim, Grace; Morris, Jonathan; Anand, Naveen; DePalma, Fedele; Greenwald, Bruce D.; Kim, Raymond E.; Laczek, Jeffery; Lee, Woo Jung; Papadopoulas, Ioannis; Uradomo, Lance; Young, Patrick E.; Darwin, Peter

doi:10.4103/eus.eus_35_19

Cited by 13 publications

(13 citation statements)

References 18 publications

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“…Rodriguez et al showed that an AS tends to be an isoechoic or hypoechoic mass with well-defined, smooth borders on EUS [ 73 ]. Kim et al reported that the IOR of determining whether or not the pancreatic lesion is IPAS is fair ( K = 0.37) [ 74 ] ( Table 4 ). They also reported that the sensitivity and specificity for IPAS were greater than 70%.…”

Section: Other Diseasesmentioning

confidence: 99%

Interobserver Reliability of Endoscopic Ultrasonography: Literature Review

et al. 2020

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Endoscopic ultrasonography (EUS) has been applied to the diagnosis of various digestive disorders. Although it has been widely accepted and its diagnostic value is high, the dependence of EUS diagnosis on image interpretation done by the endosonographer has persisted as an important difficulty. Consequently, high interobserver reliability (IOR) in EUS diagnosis is important to demonstrate the reliability of EUS diagnosis. We reviewed the literature on the IOR of EUS diagnosis for various diseases such as chronic pancreatitis, pancreatic solid/cystic mass, lymphadenopathy, and gastrointestinal and subepithelial lesions. The IOR of EUS diagnosis differs depending on the disease; moreover, EUS findings with high IOR and those with IOR that was not necessarily high were used as diagnostic criteria. Therefore, to further increase the value of EUS diagnosis, EUS diagnostic criteria with high diagnostic characteristics based on EUS findings with high IOR must be established.

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Section: Other Diseasesmentioning

confidence: 99%

Interobserver Reliability of Endoscopic Ultrasonography: Literature Review

et al. 2020

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“…Presence of AS on imaging studies can mimic a neoplastic process 3,14,15 . Kim et al demonstrated only an overall fair interobserver agreement while identifying AS on imaging features alone 16 . The differential diagnosis includes a reactive lymph node, lymphoproliferative disorder, lymphoepithelial cyst, pancreatic neuroendocrine tumor (PanNET), solid pseudopapillary neoplasm (SPN), and acinar cell carcinoma (ACC).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound‐guided fine needle aspiration of accessory spleen: Cytomorphologic features and diagnostic considerations

Gilani

Muniraj

Farrell

et al. 2020

Diagnostic Cytopathology

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Background Accessory spleen/or splenule (AS) can involve pancreas/or peripancreatic tissue and present as a mass‐forming lesion, and on imaging studies, it stimulates concern for a neoplastic process. The current study reported the largest cohort of AS cases evaluated by endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA). Methods We retrospectively reviewed our data base system for cases underwent EUS‐FNA for pancreatic/or peripancreatic lesions, with “AS” in diagnosis or in note/or with a clinical concern in the history, from January 2010 to August 2019. Corresponding cytology slides were re‐reviewed to identify the key cytomorphologic features. Results We identified 25 AS cases from 15 female and 10 male patients with a mean age of 55 years. Most patients presented with non‐specific clinical symptoms or were identified as an incidental mass lesion. Majority of the lesions were located in or around the pancreatic tail region (68%) while the remainder in perisplenic region (32%). Rapid on‐site evaluation (ROSE) was performed in nearly half of the cases (48%). Cytologically, AS shows a mixed population of medium to small‐sized lymphocytes, clusters of lymphoid cells (LC), prominent vascularity (PV), scattered mixed inflammatory cells including eosinophils, and large platelet aggregates (LPAs). Among them, LC (P = .0079), PV and LPAs were the most helpful features for cytological diagnosis. Conclusion AS is a benign entity and may pose a diagnostic challenge due to its resemblance to a neoplastic process on imaging studies. EUS‐FNA is an important tool to recognize AS by identifying its key cytologic features, thus may help to avoid unnecessary surgical management.

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“…Accessory spleens are located in the pancreatic tail in a significant minority of cases (5.5%) and can be particularly diagnostically challenging, with a high risk of misdiagnosis as hypervascular pancreatic tumours (Spencer et al 2010;Osher et al 2016;Vikse et al 2017;Ding et al 2018) leading to unnecessary biopsy procedures or surgery. Interobserver disagreement for diagnosis of intrapancreatic AS was found to be substantial with endoscopic US (Kim et al 2019). In particular, for diagnosis of AS in atypical locations (endoscopic), US-guided fine-needle aspiration biopsy (FNAB) may be useful (Tatsas et al 2012;Hocke et al 2013Hocke et al , 2017Gilani et al 2020).…”

Section: Accessory Spleen and Splenosismentioning

confidence: 99%

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

Trenker

Görg

Freeman

et al. 2021

Ultrasound in Medicine & Biology

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The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.In patients with splenomegaly (>13 £ 6 cm), an imaging, clinical and laboratory evaluation is usually required to determine the underlying cause.Most congenital variants of the spleen, and accessory spleens, have characteristic ultrasound appearances and do not require further evaluation or follow-up.The use of ultrasound contrast microbubbles (contrast-enhanced ultrasound) is of particular value in ultrasound imaging of the spleen when an indeterminate incidental finding is encountered.Splenosis can be confidently diagnosed with contrast-enhanced ultrasound and usually requires no additional imaging or follow-up.The cause of an inhomogeneous splenic parenchyma must be clarified, especially to exclude sarcoidosis or lymphomatous infiltration. Incidental indeterminate focal splenic lesions (with the exception of simple cysts) are often best managed by an interval follow-up examination (initially after 3 months) unless there clearly malignant clinical or sonographic features.For splenic calcifications, including the "starry sky" spleen, no follow-up is necessary.

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Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability

Cited by 13 publications

References 18 publications

Interobserver Reliability of Endoscopic Ultrasonography: Literature Review

Interobserver Reliability of Endoscopic Ultrasonography: Literature Review

Endoscopic ultrasound‐guided fine needle aspiration of accessory spleen: Cytomorphologic features and diagnostic considerations

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

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