EUS in the evaluation of pancreatic cystic lesions

Song, Moon Hee; Lee, Sung Koo; Kim, Myung–Hwan; Lee, Hyun Ju; Kim, Kyu-Pyo; Kim, Hyun Jun; Lee, Sang Soo; Seo, Dong Wan; Min, Young Il

doi:10.1016/s0016-5107(03)70026-1

Cited by 101 publications

(71 citation statements)

References 26 publications

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“…Song et al [6] , showed that pseudocysts exhibited echogenic debris and parenchymal changes more often than cystic tumors did (29% vs 6% and 65% vs 4%, respectively), but these features were neither specific nor sensitive. Mural nodules were also insensitive but moderately specific in that study (56% in cystic neoplasms vs 12% in pseudocysts.…”

Section: Figurementioning

confidence: 98%

“…Endoscopic ultrasound (EUS) is rapidly becoming the imaging modality of choice for a variety of pancreatic lesions; however the role of the endosonographic features alone is controversial and EUS alone may not be sufficiently reliable in differentiating between serous and mucinous www.wjgnet.com lesions [5,6] . Analysis of the cyst fluid for CEA, CA 19-9 and cytology may help in differentiating pancreatic cystic lesions [7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

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Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

Aljebreen

Romagnuolo²,

Perini³

et al. 2007

WJG

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AIM:To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. METHODS:46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiveroperator characteristics (ROC) curve analysis was performed. RESULTS:The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/premalignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffs were 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs.CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions.

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Section: Figurementioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

Aljebreen

Romagnuolo²,

Perini³

et al. 2007

WJG

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“…For example, pseudocysts are more likely to be unilocular and exhibit internal echogenic debris and surrounding pancreatic parenchymal abnormalities suggestive of pancreatitis, whereas cyst septations, solid component, and mural nodules occur more frequently in cystic tumors (50). SCA on the other hand are more likely to have a honeycomb appearance or multiple small (<3 mm) cysts (50), although an oligocystic variety with fewer and larger cysts is less frequently encountered.…”

Section: Imaging (Level 2-3)mentioning

confidence: 99%

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

Khalid¹,

Brugge²

2007

Am J Gastroenterology

290

197

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The diagnosis and management of pancreatic cystic lesions is a common problem. At least 1% of hospitalized patients at major medical centers will have a pancreatic cystic lesion on cross sectional imaging. Up to a quarter of all pancreata examined in an autopsy series contained a pancreatic cyst, 16% of which were lined by an "atypical" epithelium and 3% of which had progressed to carcinoma-in-situ (high grade dysplasia). in the past, it was thought these cystic lesions were benign, but increasing evidence points to the cystic lesions as being the origin of some pancreatic malignancies.The most important clinical tools in the diagnosis and management of pancreatic cystic lesions are cross sectional imaging, endoscopic ultrasound, and cyst fluid analysis. The most important differential diagnosis is distinguishing mucinous (pre-malignant) and non-mucinous cystic lesions. The findings of a macrocystic lesion containing viscous fluid rich in CEA are supportive of a diagnosis of a mucinous lesion. Serous lesion are the most common non-mucinous cyst and are characterized by a microcystic morphology, non-viscous fluid and a low concentration of CEA in the cyst fluid.The following document includes a description of neoplastic pancreatic cysts, a critical review of relevant diagnostic tests, and a discussion of treatment options. We have proposed a set of guidelines for the diagnonis and management of patients with neoplastic pancreatic cysts. The guidelines are based on published data backed by an analysis of the quality of the data and are designed to address the most frequent and important clinical scenarios. In addition to providing a summary of the diagnostic data, we offer diagnostic and management suggestions based on 13 common clinical problems. Although the field is rapidly evolving, a set of core principles is provided based on a balance between the risk of malignancy and the benefit of pancreatic resection.

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“…EUS has been reported to be useful to detect various pancreatic lesions, 5,11 and in these days, many procedures has been used for diagnosis or treatment with this technique. [12][13][14][15][16] Endoscopic drainage of pancreatic pseudocysts has become an accepted alternative to surgery when intervention is indicated.…”

Section: Discussionmentioning

confidence: 99%

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

Ahn

Seo²,

Eum³

et al. 2010

Gut Liver

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Background/Aims: With the progress of product development, single-step endoscopic ultrasound (EUS)-guided transmural drainage can overcome some disadvantages of the blind or two-step procedures used in the treatment of pancreatic pseudocysts. We therefore evaluated the technical feasibility, efficacy, and safety of single-step EUS-guided transmural drainage of pancreatic pseudocysts. Methods: Endoscopic drainage of pancreatic pseudocysts was performed in 47 patients (median age, 46 years; range, 38 years to 59 years; 40 men) by using interventional echoendoscopes with a single-step device suitable for ballooning, bougination, and plastic-stent insertion. Results: Endoscopic stent placement was successful in 42 patients (89%; transgastric approach, 34/38; transduodenal approach, 8/9) and failed in 5 patients because of acute angulation (n=4) or small cyst (n=1). The volume of the pseudocyst was reduced by more than 90% or it disappeared completely in all of 41 patients (100%), based on a mean follow-up period of 17 months (range, 11 months to 20 months). The overall recurrence rate was 12% (5/41) after improvement by the procedure. Minor complications (one case of bleeding, three cases of pneumoperitoneum, and one case of peritonitis) occurred after the procedure in five patients (11%), but there were no major complications. Conclusions: Single-step EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety. (Gut Liver 2010;4:524-529)

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EUS in the evaluation of pancreatic cystic lesions

Cited by 101 publications

References 26 publications

Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

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