The Role of Molecular Analysis in the Diagnosis and Surveillance of Pancreatic Cystic Neoplasms

Winner, Megan; Sethi, Amrita; Poneros, John M.; Stavropoulos, Stavros N.; Francisco, Peter; Lightdale, Charles J.; Allendorf, John D.; Stevens, Peter D.; Gonda, Tamas A.

doi:10.6092/1590-8577/2941

Cited by 13 publications

(1 citation statement)

References 18 publications

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“…Following this possibility, of 60 cystadenomata only 6 were defined as MCN. This small number of patients with differing epidemiological data when compared to the literature (median age 68 years; thus, far higher than 45 to 48 years; lower female percentage of 83.3 % when compared to 95 % [19] to 99.7 % [11,14]; median cystic size with 3.5 cm smaller than 5 to 8.7 cm [14,20]; localization less often in pancreas corpus or tail (50 % versus up to 97 % [14,21], respectively) might underline the explanation given above.…”

Section: Discussionmentioning

confidence: 74%

Cystic pancreatic neoplasms in a tertiary gastroenterologic referral center: Evaluation of the diagnostic accuracy of endoscopic ultrasound, progression rate and malignancy rate in a large unicentric cohort

et al. 2022

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Introduction Cystic pancreatic neoplasms (CPN) are frequently diagnosed due to better diagnostic techniques and patients becoming older. However, diagnostic accuracy of endoscopic ultrasound (EUS) and value of follow-up are still unclear. Material and Methods The aim of our retrospective study was to investigate the frequency of different cystic pancreatic neoplasms (intraductal papillary mucinous neoplasm [IPMN], serous and mucinous cystadenoma, solid pseudopapillary neoplasia), diagnostic accuracy, size progression, and rate of malignancy using EUS in a tertiary reference center in Germany. Between January 1, 2012 and December 31, 2018, 455 patients were diagnosed with cystic pancreatic lesions (798 EUS examinations). Results Endoscopic ultrasound diagnosed 223 patients with cystic pancreatic neoplasms, including 138 (61.9%) patients with branch duct IPMN, 16 (7.2%) with main duct IPMN, and five (2.2%) with mixed-type IPMN. In the largest subgroup of branch duct IPMN, cysts were size progressive in 20 patients (38.5%). Fine needle aspiration (FNA) was performed in 21 patients, and confirmed the suspected diagnosis in 12/21 patients. 28 surgical resections were performed, in 7/28 patients (25%), high-grade dysplasia or cancer was diagnosed. Endoscopic ultrasound diagnosis of serous and mucinous cystic pancreatic neoplasms was correct in 68.4%. Conclusions Endoscopic ultrasound differential diagnosis of CPNs is challenging. Even in a tertiary expert center, differentiation of serous and mucinous cystic neoplasia is not guaranteed. Relevant size progression of CPN, however, is rare, as is the rate of malignancy. The data of this study suggest that morphologic criteria to assess pancreatic cysts alone are not sufficient to allow a clear diagnosis. Hence, for the improved assessment of pancreatic cysts, EUS should be combined with additional tests and techniques such as MRT/MRCP, contrast-enhanced EUS, and/or FNA/fine needle biopsy including fluid analysis. The combination and correlation of imaging studies with EUS findings is mandatory.

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