Endoscopic ultrasonography evaluation for pancreatic cysts: Necessity or overkill?

Abstract

Incidental pancreatic cysts have become gradually more recognized in clinical practice as a result of increased use of transabdominal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). These lesions consist of inflammatory cysts (pseudocysts) and pancreatic cystic neoplasms (PCN) which have been classified as benign, premalignant and malignant. The diagnosis and management strategy of incidentally discovered pancreatic cysts can be challenging as the majority of them are PCN and CT or MRI alone may not be sufficient to provide an accurate diagnosis. Endoscopic ultrasound (EUS)-guided fine-needle aspiration provides a method to obtain cyst fluid for analysis and the recently developed EUSbased technology including contrast-enhanced ultrasound, cystoscopy and needle-based confocal laser endomicroscopy allows endosonographers to gain additional useful information. The current data suggest that EUS evaluation of pancreatic cysts offers some benefits especially in cases of inconclusive CT or MRI.

Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

“…Although molecular analyses are considered to be very promising, a truly accurate and reliable marker has yet to be identified. Data on the use of needle‐based confocal laser endomicroscopy (CLE) are promising, even if better interobserver agreement and validation are needed …”

“…Data on the use of needlebased confocal laser endomicroscopy (CLE) are promising, even if better interobserver agreement and validation are needed. [9][10][11] As a result of the very low number of intracystic neoplastic cells, the yield of cystic fluid cytology is disappointing, with accuracy rates well below 50%. [12][13][14] .…”

Endoscopic diagnosis of cystic lesions of the pancreas

“…Main pancreatic duct (MPD) communication is important in differentiating IPMN from SN and MCN. EUS is equivalent to magnetic resonance imaging (MRI) in detecting MPD communication in pancreatic cysts . For example, EUS evaluation of 76 patients with cystic tumors of the pancreas found that eight of 11 monocular cystic tumors were non‐neoplastic cysts, 11 of 13 SN had microcystic areas, and MN was present in 25% of MCN and in 38% of IPMN .…”

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

“…EUS‐FNA has been widely used as a safe, precise, and less invasive procedure for obtaining pathological materials from pancreatic lesions . Because of these features, EUS and EUS‐FNA are regarded as important tools for differentiating mucinous neoplastic cysts, such as IPMN and MCN, from other cysts and for diagnosing the malignant transformation of these cysts, even with drawbacks of EUS, such as operator‐dependent procedure and relatively invasive nature in comparison with cross‐sectional studies . Furthermore, there are some discrepancies in the recommended application of EUS and EUS‐FNA between the guidelines.…”