The Role of EUS in Cystic Lesions of the Pancreas

Al‐Haddad, Mohammad; DeWitt, John M.

doi:10.1007/978-1-60327-480-7_13

Clinical Gastroenterology

2010

DOI: 10.1007/978-1-60327-480-7_13

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The Role of EUS in Cystic Lesions of the Pancreas

Mohammad Al‐Haddad

John M. DeWitt

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Cited by 3 publications

References 92 publications

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Role of emerging molecular markers in pancreatic cyst fluid

Al‐Haddad¹

2015

Endosc Ultrasound

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Cystic lesions of the pancreas (CLPs) are increasingly diagnosed due to the growing utilization of cross-sectional imaging modalities. The differentiation between true cysts (epithelial tumors) and nonepithelial lesions (such as pseudocysts) relies on clinical and imaging characteristics, but more reliably obtained by endoscopic ultrasound (EUS) fine-needle aspiration. Due to their malignant potential, some of the true pancreatic cysts require further assessment and periodic follow-up. Therefore, it is important to establish a solid diagnosis at the time of detection of the various types of pancreatic cysts. Due to the limitations of cytology and biochemical markers in accurately classifying cyst pathology, the search for specific molecular markers associated with each type of cyst is ongoing. In this chapter, we will review some of the emerging molecular markers in pancreatic cystic fluid and their potential impact on endosonography and pancreatic cyst management.

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Role of emerging molecular markers in pancreatic cyst fluid

Al‐Haddad¹

2015

Endosc Ultrasound

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The diagnostic value of EUS in pancreatic cystic neoplasms compared with CT and MRI

Zhang

et al. 2015

Endosc Ultrasound

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Background and Objectives:Pancreatic cystic neoplasms (PCNs) are being increasingly identified. Recent reports have described the utility of endoscopic ultrasound (EUS) in the characterization of PCNs. This study presents the diagnostic value of EUS in PCNs.Materials and Methods:A total of 108 patients (78 women and 30 men; average age, 50 years) who were confirmed pathologically to have PCNs were analyzed retrospectively. We analyzed the clinical characteristics of 108 patients and compared the diagnostic performance of computed tomography (CT), magnetic resonance imaging (MRI), and EUS with or without fine-needle aspiration (FNA).Results:EUS with or without FNA significantly increased the accuracy for diagnosing PCNs compared with CT (P = 0.002) and MRI (P = 0.006). According to the tumor size, the further analysis of these impacts was provided. EUS was superior to CT in the characterization of PCNs in small (< 3 cm) lesions (P = 0.003), similarly superior to MRI in large (>3 cm) lesions (P = 0.030). Furthermore, EUS is valuable for precisely characterizing internal structures, for example, septa (P = 0.004, compared with CT; P = 0.033, compared with MRI) and mural nodules (P = 0.028, compared with CT).Conclusions:In our study, EUS with or without FNA is the ideal tool for providing detailed imaging of PCNs and performed better than MRI and CT.

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Molecular analysis of pancreatic cyst fluid changes clinical management

et al. 2018

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Background and Objectives:DNA molecular analysis has been suggested as a tool to evaluate pancreatic cysts. This study assesses whether the addition of DNA molecular analysis alters clinical management.Methods:This is a retrospective review of 46 consecutive patients who underwent EUS-FNA of pancreatic cysts with DNA molecular analysis at two major academic institutions. Cases were presented to two pancreaticobiliary surgeons first without and then with DNA molecular analysis data. The primary outcome was the frequency with which clinical management was altered with the addition of DNA molecular analysis.Results:Forty-six patients with a mean age of 62.0 (±13.4) years and mean cyst size of 3.2 (±2.3) cm were included in the study. Cyst carcinoembryonic antigen (CEA) was available in 30 patients and ranged from 0.4 to 15,927 ng/mL. DNA molecular analysis was described as benign in 23 (50%), statistically indolent in 13 (28%), statistically higher risk in 9 (20%), and indeterminate in 1 (2%). Surgeon #1 changed the management in 13/46 cases (28%) and surgeon #2 changed the management in 12/46 cases (26%) with the addition of DNA molecular analysis. When organized by CEA concentration, those with an intermediate CEA (45–800 ng/mL) or without a CEA concentration had a management changed more frequently (40%) compared to all others (P < 0.05).Conclusions:The addition of DNA molecular analysis alters the clinical management of pancreatic cystic lesions most often when CEA levels are intermediate (45–800 ng/mL) or when no CEA concentration is available. Use of DNA molecular analysis can be considered in this cohort. Further study of molecular markers in pancreatic cystic lesions is recommended.

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The Role of EUS in Cystic Lesions of the Pancreas

Cited by 3 publications

References 92 publications

Role of emerging molecular markers in pancreatic cyst fluid

Role of emerging molecular markers in pancreatic cyst fluid

The diagnostic value of EUS in pancreatic cystic neoplasms compared with CT and MRI

Molecular analysis of pancreatic cyst fluid changes clinical management

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