Factors Determining Diagnostic Yield of Endoscopic Ultrasound Guided Fine-Needle Aspiration for Pancreatic Cystic Lesions: A Multicentre Asian Study

Lim, Lee Yong; Lakhtakia, Sandeep; Ang, Tiing Leong; Vu, Charles; Dy, Frederick; Chong, Vui Heng; Khor, Christopher Jen Lock; Lim, Wee Chian; Doshi, Bhavesh; Varadarajulu, Shyam; Yasuda, Kenjiro; Wong, Jennie; Chan, Yiong Huak; Nga, Min En; Ho, Khek Yu

doi:10.1007/s10620-012-2528-2

Cited by 58 publications

(37 citation statements)

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“…One of the main limitations, however, is the significant variability between observers (68) in the description of morphological findings. This can be implemented with the performance of fine needle aspiration (FNA) targeting cyst fluid, intracystic components, pancreatic ducts or lymph nodes (69,70). Moreover, it has been reported that the combined use of EUS-FNA with a high-resolution imaging modality can increase the diagnostic accuracy up to 54% (71).…”

Section: Endoscopic Modalitiesmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

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Section: Endoscopic Modalitiesmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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“…Such pancreatic cysts may benefit from EUS-guided biopsy but should be correlated to the clinical presentation. As Lim et al [3] suggest in this study, the cytologic yield of fluid alone remains poor, but FNA is useful especially with multiple passes when solid components are present. Accordingly, further studies are needed to test the hypothesis that EUS-FNA may not be needed in the absence of solid components, although all other cysts may still benefit from a diagnostic EUS imaging study.…”

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confidence: 63%

“…In some cases, however, biopsy of solid material or aspiration of cyst fluid is essential to confirm the diagnosis. Thus, when a pancreas cyst is detected on CT or MRI, the clinical question often arises as to whether EUS should be performed and, furthermore, if additional FNA or biopsy is helpful.In this month's issue of Digestive Diseases and Sciences, Lim et al [3] report their findings in ''Factors determining diagnostic yield of EUS guided fine-needle aspiration for pancreatic cystic lesions: a multicenter Asian study.'' The authors include a multicenter analysis of 298 patients with diverse pancreatic cystic lesions who underwent EUS of whom 132 (44 %) underwent EUS-FNA.…”

mentioning

confidence: 99%

“…In this month's issue of Digestive Diseases and Sciences, Lim et al [3] report their findings in ''Factors determining diagnostic yield of EUS guided fine-needle aspiration for pancreatic cystic lesions: a multicenter Asian study.'' The authors include a multicenter analysis of 298 patients with diverse pancreatic cystic lesions who underwent EUS of whom 132 (44 %) underwent EUS-FNA.…”

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confidence: 99%

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EUS for Pancreas Cysts: What Should We Be Sampling?

Sreenarasimhaiah

2013

Dig Dis Sci

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The growing resolution and more frequent use of imaging methods has increasingly identified pancreatic cysts, ranging from benign serous and pseudocysts to premalignant or malignant mucinous cystic neoplasm (MCN). Due to the disparate course and management of benign cysts versus cystic neoplasms or pre-neoplasms, unambiguous lesion identification is essential, which is not always possible with conventional cross-sectional imaging [1]. Thus, an increasing number of centers are utilizing endoscopic ultrasound (EUS) for further characterization of pancreatic cysts with high resolution images of cyst morphology, size, presence and type of septations, presence of solid components, and the ability to sample cyst contents using fine needle aspiration (FNA) and to perform biopsies. Characteristics such as diameter [3 cm and the presence of mural nodules may be the best predictors of malignant transformation of MCN or side-branch type intraductal papillary neoplasms (SB-IPMN) [2]. In some cases, however, biopsy of solid material or aspiration of cyst fluid is essential to confirm the diagnosis. Thus, when a pancreas cyst is detected on CT or MRI, the clinical question often arises as to whether EUS should be performed and, furthermore, if additional FNA or biopsy is helpful.In this month's issue of Digestive Diseases and Sciences, Lim et al. [3] report their findings in ''Factors determining diagnostic yield of EUS guided fine-needle aspiration for pancreatic cystic lesions: a multicenter Asian study.'' The authors include a multicenter analysis of 298 patients with diverse pancreatic cystic lesions who underwent EUS of whom 132 (44 %) underwent EUS-FNA.FNA cytology with a single pass was only 29 % when solid components are not present. Furthermore, their study demonstrated a higher yield (44 %) when solid components were biopsied during a single pass, which increased to 78 % with multiple passes. Although biochemical markers such as carcinogenic embryonic antigen (CEA) and amylase measured in cyst fluid aspirates are frequently used to aid in diagnosis of pancreatic cysts, the authors focused on cytologic yield from EUS-FNA. In the literature, the overall yield of EUS-FNA for cytologic analysis of indeterminate pancreatic cystic lesions is 31-37 % [2,4].Morphologic features noted by high resolution EUS images of small pancreatic cysts can help differentiate mucinous-type cysts from others. Nevertheless, in a recent study, expert endosonographers were evaluated for their ability to make a diagnosis of pancreatic MCN based on EUS appearance alone without FNA. The accuracy was only 23-46 % despite the use septations, mural nodules, solid components, and communication with the pancreatic duct as criteria [5]. Therefore, FNA for fluid analysis or biopsy of solid materials may add to diagnostic yield, particularly for indeterminate cysts. Solid material within a cyst may represent debris but could also arise from malignancy.Several studies have addressed the acquisition of pancreatic cyst specimens and types of analysis that ...

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“…The most common diagnosis was PP followed by intraductal papillary mucinous neoplasm. 9 That study included 97 subjects with PP diagnosed according to EUS criteria. The mean cyst size was 4.5 cm in all 298 patients.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Pancreatic Pseudocysts with True Pancreatic Cysts According to Endosonographic Criteria(A Six-Year Retrospective Analysis)

Şahin¹,

Karakan²,

Cındoruk³

2015

Turkiye Klinikleri J Gastroenterohepatol

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27A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : During the past years, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has become an important tool in cyst therapy and tissue sampling. In this retrospective analysis, the primary objective was to determine the efficacy of EUS guided FNA for diagnosis of pancreatic pseudocysts (PP) and true cysts. The secondary aim was to evaluate the size and location of the cysts. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Eighty-three patients with pancreatic cysts and pseudocysts were retrospectively identified from the database of Gazi University Department of Gastroenterology. Size of the cysts and available data on fine needle aspiration and surgical aspiration were also recorded. R Re es su ul lt ts s: : According to EUS criteria, 48 patients (57.8%), 24 female and 24 male subjects with PP and 35 (42.2%) patients (24 female and 11 male) with cystic lesions (totally 83 patients, 48 female and 35 male) were enrolled in the study. The size of the cysts in the pseudocyst group was significantly greater than that of the simple cysts. There was no difference between the two groups in terms of patients age. There was also no difference between the two study groups in terms of location (p= 0.404). The most common location for both cysts was the head of the pancreas. Normal cytology was the most common finding among cytological results of fine needle aspiration in the both groups. Bacterial growth was detected in one sample and fungal culture was positive in another in the PP group. One of the samples showed atypical cells and another demonstrated mucinous cells in the same subgroup. There were 4 (11.4%) cases with mucinous cystic neoplasm and one case with cystadenocarcinoma in the true cyst group. C Co on nc cl lu us si io on n: : Cysts of the pancreas have some characteristic properties that can be differentiated with EUS guidance. K Ke ey y W Wo or rd ds s: : Biopsy, fine-needle; endosonography; pancreas; cysts Ö ÖZ ZE ET T A Am ma aç ç: : Son yıllarda, Endoskopik Ultrason (EUS) eşliğinde yapilan ince iğne aspirasyon işlemi (FNA) kist tedavisi ve kistin içeriğinden örnek alımında önemli yer tutmaya başlamıştır. Yaptığımız bu retrospektif analizde EUS yolu ile ince iğne biyopsisinin pankreatik kist ve psödokistlerdeki tanısal etkinliği incelenmiştir. İkincil amaç olarak psödokistlerin ve gerçek kistlerin boyut ve lokalizasyon açısından farklılığı analiz edilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Retrospektif olarak elde edilen ve psödokist ile gerçek pankreatik kist tanısı alan 83 hastanın bilgileri Gazi Üniversitesi Gastroenteroloji Bölümü veritabanından elde edilmiştir.Bu veriler ile kist boyutları ve sonradan elde edilen ince iğne aspirasyon ve cerrahi patolojik sonuçlar değerlendirilip analiz edilmiştir. B Bu ul lg gu ul la ar r: : Değerlendirilen toplam vaka sayısı 83 (48 kadın ve 35 erkek) olup yapılan karşılaştırmada 24 kadın ve 24 erkek hastadan oluşan 48 (%57,8) hasta pankreatik psödokist olarak ele alın...

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Factors Determining Diagnostic Yield of Endoscopic Ultrasound Guided Fine-Needle Aspiration for Pancreatic Cystic Lesions: A Multicentre Asian Study

Abstract: The cytologic yield of EUS-FNA was 47 %. When a solid component was present in the cyst, doing more than one pass during EUS-FNA increased its diagnostic yield.

Cited by 58 publications

References 10 publications

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

EUS for Pancreas Cysts: What Should We Be Sampling?

A Comparison of Pancreatic Pseudocysts with True Pancreatic Cysts According to Endosonographic Criteria(A Six-Year Retrospective Analysis)

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