Excellent Accuracy of Glucose Level in Cystic Fluid for Diagnosis of Pancreatic Mucinous Cysts

Faias, Sandra; Pereira, Luísa; Roque, Rúben; Chaves, Paula; Torres, Joana; Cravo, Marília; Pereira, António Dias

doi:10.1007/s10620-019-05936-5

Cited by 34 publications

(32 citation statements)

References 17 publications

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“…As a result, clinicians apply an aggressive treatment strategy and a significant number of patients with ASCN undergo unnecessary surgery. Furthermore, endoscopic ultrasonography helped in improving diagnostic accuracy with biopsy or cyst fluid analysis guided by it, but its widespread use is difficult to achieve in clinical settings due to invasiveness and complex procedures (12,13). Therefore, it would be of great utility to develop an accurate, non-invasive, and convenient diagnostic tool for ASCN and MCN patients.…”

Section: Introductionmentioning

confidence: 99%

CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas

et al. 2021

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ObjectivesTo investigate the value of CT-based radiomics analysis in preoperatively discriminating pancreatic mucinous cystic neoplasms (MCN) and atypical serous cystadenomas (ASCN).MethodsA total of 103 MCN and 113 ASCN patients who underwent surgery were retrospectively enrolled. A total of 764 radiomics features were extracted from preoperative CT images. The optimal features were selected by Mann-Whitney U test and minimum redundancy and maximum relevance method. The radiomics score (Rad-score) was then built using random forest algorithm. Radiological/clinical features were also assessed for each patient. Multivariable logistic regression was used to construct a radiological model. The performance of the Rad-score and the radiological model was evaluated using 10-fold cross-validation for area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.ResultsTen screened optimal features were identified and the Rad-score was then built based on them. The radiological model was built based on four radiological/clinical factors. In the 10-fold cross-validation, the Rad-score was proved to be robust and reliable (average AUC: 0.784, sensitivity: 0.847, specificity: 0.745, PPV: 0.767, NPV: 0.849, accuracy: 0.793). The radiological model performed slightly less well in classification (average AUC: average AUC: 0.734 sensitivity: 0.748, specificity: 0.705, PPV: 0.732, NPV: 0.798, accuracy: 0.728.ConclusionsThe CT-based radiomics analysis provided promising performance for preoperatively discriminating MCN from ASCN and showed good potential in improving diagnostic power, which may serve as a novel tool for guiding clinical decision-making for these patients.

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Section: Introductionmentioning

confidence: 99%

CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas

et al. 2021

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“…This imperfect performance of CEA highlights the need of better biomarkers in PCLs. PCF glucose may be more advantageous than CEA in routine diagnosis of small pancreatic mucinous cysts, reducing "indeterminate" diagnosis and requiring minimal amount of PCF as shown by others and ourselves in a recently published study [24][25][26].…”

Section: Discussionmentioning

confidence: 92%

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

Faias

Cravo

Silva³

et al. 2020

BMC Gastroenterol

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Background In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features (size ≥ 3 cm, mural nodule, or Wirsung dilation). Objective To evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm. Methods Retrospective study of PCLs < 3 cm (2007–2016) undergoing EUS-FNA. Clinical, EUS and pancreatic cystic fluid (PCF) data were prospectively registered. Performance of EUS-FNA with PCF analysis for the detection of malignancy and accuracy in surgical cohort were analyzed. Results We evaluated 115 patients with PCLs < 3 cm who underwent EUS-FNA. 19 patients underwent surgery, 7 had malignant, 8 pre-malignant, and the remaining 4 benign lesions. Mass/mural nodule was present in 27% of the cysts, CEA level was higher than 192 ng/mL in 39.4% of patients, and only 35% of cytologic samples were informative. Nevertheless, additional FNA for PCF analysis improved the diagnostic performance of EUS imaging—AUC = 0.80 versus AUC = 60. Conclusion EUS-FNA has good accuracy in PCLs < 3 cm. It confirmed malignancy even in lesions without worrisome features (nodule/mass), with two in every five resections showing high-risk/malignant lesions. EUS-FNA was also useful to diagnose benign cysts, possibly allowing surveillance to be stopped in one in every five patients.

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“…Consequently, it cannot per se justify repeating the EUS‐FNA. According to a recently published study by our group, glucose level in PCF during the first EUS‐FNA may complement inconclusive cases in which CEA levels fall between 5 and 192 ng/mL 21 …”

Section: Discussionmentioning

confidence: 97%

A second endoscopic ultrasound with fine‐needle aspiration for cytology identifies high‐risk pancreatic cysts overlooked by current guidelines

Faias

Pereira

Fonseca

et al. 2020

Diagnostic Cytopathology

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Background Endoscopic ultrasound with fine‐needle aspiration (EUS‐FNA) is recommended for diagnosis of pancreatic cystic lesions (PCLs). Its role in surveillance is unclear. Our goal was to determine if a second EUS‐FNA changes diagnosis or management of PCLs. Methods A retrospective analysis of an EUS database, searching for EUS‐FNAs in PCLs from 2007 to 2017 was performed. Demographics, cyst characteristics, and FNA results were compared in patients under surveillance, performing a single or two consecutive EUS‐FNAs. Results Of 203 PCLs referred for EUS‐FNA, surveillance was decided in 128 (63%). Data of 105 (82%) patients with a single EUS‐FNA were compared with 23 (18%) with two EUS‐FNAs during surveillance. Patients were younger in this latter group (P = .055), whereas CEA levels were marginally higher (P = .078) and a mass/nodule were more frequent (P = .006). The mean time between EUS‐FNAs was 38 months (4.7‐118.8) for 18 patients maintaining surveillance vs 18 months (2.9‐56.9) in the four referred for surgery (P = NS) after two EUS‐FNAs (two NETs, one IPMN‐HGD, and one MCN‐LG). A high correlation in CEA level between consecutive EUS‐FNAs (r2 = 0.945, P < .01) was present, with a change of category observed (cut‐off level = 192 ng/mL) in two patients only. Of four patients with a second EUS‐FNA with conclusive cytology, two had NETs confirmed on resection. Conclusions Repeating EUS‐FNA in surveillance of PCLs with clinical suspicion of malignancy increased neoplasm diagnoses, changing decision toward surgery in almost 20% of patients while excluding IPMNs with mucin nodules from unnecessary resections. A second EUS‐FNA for cytology appears justified in some PCLs, particularly for diagnosing NETs.

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Excellent Accuracy of Glucose Level in Cystic Fluid for Diagnosis of Pancreatic Mucinous Cysts

Cited by 34 publications

References 17 publications

CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas

CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

A second endoscopic ultrasound with fine‐needle aspiration for cytology identifies high‐risk pancreatic cysts overlooked by current guidelines

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