Pancreatic cysts: Is the answer on the wall?

Nakai, Yousuke; Koike, Kazuhiko

doi:10.1111/den.13223

Cited by 3 publications

(2 citation statements)

References 10 publications

(15 reference statements)

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“…Although a close relationship between ST and pancreatic ductal carcinoma is known, the association of ST and the onset of IC have not been investigated in detail. As a method to diagnose ST directly, Nakai and Koike reported EUS‐guided through‐the‐needle biopsy such as a targeted wall puncture. Although this procedure is not common in Japan because of the risk of dissemination, they reported that it has the potential to be useful for evaluating the degree of dysplasia and stroma in BD‐ and mixed‐IPMN with ST.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

Iwaya

Hijioka²,

Mizuno³

et al. 2019

Digestive Endoscopy

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Background and Aim Septal thickness (ST) can predict a malignant branch‐duct (BD) and mixed‐type intraductal papillary mucinous neoplasm (IPMN) of the pancreas, but its cut‐off value has not been established. The aim of the present study was to determine the optimal ST cut‐off value to predict malignancy using endoscopic ultrasound (EUS). Methods We retrospectively identified 200 patients with IPMN, including 132 with BD‐ and mixed‐IPMN, who underwent surgical resection between 1989 and 2017. ST was defined as the septum or lesion wall with the maximum diameter in BD‐ and mixed‐IPMN. The possibility of ST as a malignant predictor was examined, as well as the diagnostic ability of ST combined with mural nodule (MN) height for malignant IPMN. Results Among the 132 IPMN patients, pathological diagnosis was benign in 81 (61.4%) and malignant in 51 (38.6%). Area under the curve for the diagnosis of malignancy using ST was 0.74 for pathological specimens, 0.70 for EUS and 0.56 for computed tomography. Multivariate analysis showed that the odds ratios for ST ≥2.5 mm and MN height ≥5 mm were 3.51 [95% confidence interval (CI), 1.55–7.97, P = 0.003] and 3.36 (95% CI, 1.52–7.45, P = 0.003), respectively. Conclusions Septal thickness was an independent predictive factor similar to MN height for malignant IPMN in a multivariate analysis. The ST on EUS appeared to be the thickness of a fibrotic septum associated with the malignant transformation of IPMN. An ST cut‐off value of 2.5 mm might provide an accurate prediction of malignant IPMN.

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Section: Discussionmentioning

confidence: 99%

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

Iwaya

Hijioka²,

Mizuno³

et al. 2019

Digestive Endoscopy

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“…The transpapillary approach and EUS are useful in evaluating pancreatic cystic lesions, especially IPMN. Endoscopic diagnosis using novel techniques is useful and necessary for assessing pancreatic cystic lesions; however, clear strategies have not yet been developed . Further studies are warranted not only to improve diagnostic ability but also to determine a clear strategy for the use of novel endoscopic techniques for the diagnosis of pancreatic cystic lesions.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic diagnosis of cystic lesions of the pancreas

Kamata

Kitano

2018

Digestive Endoscopy

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Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography (EUS) and transpapillary diagnosis. EUS-guided fine-needle aspiration cytology and EUS-guided fine needle-based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules (MN) in intraductal papillary mucinous neoplasms (IPMN). Contrast-enhanced harmonic EUS (CH-EUS), as an add-on to EUS, is useful for identifying and characterizing MN. Recent studies show that CH-EUS has a sensitivity of 60-100% and a specificity of 75-92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN. A recent meta-analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN. Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.

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Endoscopic Ultrasound-Guided Through-the-Needle Biopsy: A Narrative Review of the Technique and Its Emerging Role in Pancreatic Cyst Diagnosis

Vilas-Boas,

Ribeiro,

Macedo

et al. 2024

Diagnostics

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Pancreatic cystic lesions (PCLs) pose a diagnostic challenge due to their increasing incidence and the limitations of cross-sectional imaging and endoscopic-ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-guided through the needle biopsy (EUS-TTNB) has emerged as a promising tool for improving the accuracy of cyst type determination and neoplastic risk stratification. EUS-TTNB demonstrates superior diagnostic performance over EUS-FNA, providing critical preoperative information that can significantly influence patient management and reduce unnecessary surgeries. However, the procedure has risks, with an overall adverse event rate of approximately 9%. Preventive measures and further prospective studies are essential to optimize its safety and efficacy. This review highlights the potential of EUS-TTNB to enhance the diagnostic and management approaches for patients with PCLs. It examines the current state of EUS-TTNB, including available devices, indications, procedural techniques, specimen handling, diagnostic yield, clinical impact, and associated adverse events.

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Pancreatic cysts: Is the answer on the wall?

Abstract: This Editorial refers to the article by L. Baressi, p 760‐770 of this issue.

Cited by 3 publications

References 10 publications

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

Endoscopic diagnosis of cystic lesions of the pancreas

Endoscopic Ultrasound-Guided Through-the-Needle Biopsy: A Narrative Review of the Technique and Its Emerging Role in Pancreatic Cyst Diagnosis

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