Role of endosonography in the management of incidental pancreatic cystic lesions

Kelvin, Yu Man Ching; Park, Jin-Seok; Seo, Dong–Wan

doi:10.1016/j.gii.2014.04.003

Cited by 4 publications

(15 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The accuracy of MRI and CT to make a specific diagnosis is suboptimal, with reports of 39-50 and 40-44%, respectively. Efforts to differentiate pancreatic cystic lesions from imaging tests have met with mixed success, with up to 40% of neoplastic cysts misdiagnosed as pseudocyst [3,7]. EUS, particularly as a means of EUS-guided cyst aspiration, has become an important tool in the diagnosis and risk stratification of pancreatic cysts.…”

Section: Diagnostic Role Of Eusmentioning

confidence: 99%

“…EUS, particularly as a means of EUS-guided cyst aspiration, has become an important tool in the diagnosis and risk stratification of pancreatic cysts. The diagnostic accuracy of EUS for identification of malignant or pre-malignant pancreatic cysts reaches 95%, although this method has significant limitations for the differential diagnosis of benign and malignant cysts with overall accuracy rates of 40-93% [7,11].…”

Section: Diagnostic Role Of Eusmentioning

confidence: 99%

“…Despite being the most common modality to identify cystic pancreatic lesions, cross-sectional imaging plays a variable role in characterizing these lesions. Endoscopic ultrasonography (EUS) has become an important tool in the diagnosis and risk stratification of pancreatic cysts [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Role of EUS in Pancreatic Cysts

Alizadeh¹

2017

Endoscopic Ultrasound - From Usual to Special

View full text Add to dashboard Cite

Pancreatic cystic lesions (PCLs) comprise various pathologically different groups of lesions that usually share many common clinical features. Cystic lesions and fluid collections of the pancreas often present a diagnostic and therapeutic challenge. Pancreatic cystic lesions are being diagnosed with increasing frequency owing to the widespread use of cross-sectional imaging. The differential diagnosis for cystic lesions of the pancreas is broad, and the role of endoscopic ultrasonography (EUS) is becoming more clearly defined. EUS has become an important tool in the diagnosis and risk stratification of pancreatic cysts. The ability of EUS to provide detailed imaging, tissue, and cyst fluid for analysis makes it a seemingly powerful diagnostic tool for PCLs. It can accurately visualize the cyst morphology, assess vascular pattern by contrast harmonic scan, and perform fine-needle aspiration (FNA) for evaluation of cytology and molecular markers. Furthermore, several studies have shown the therapeutic applications of endoscopic ultrasound in management of PCLs, including EUS-guided ablation of cystic pancreatic tumors by injection of alcohol, aiding in pancreatic pseudocyst drainage.

show abstract

Section: Diagnostic Role Of Eusmentioning

confidence: 99%

Section: Diagnostic Role Of Eusmentioning

confidence: 99%

See 1 more Smart Citation

The Role of EUS in Pancreatic Cysts

Alizadeh¹

2017

Endoscopic Ultrasound - From Usual to Special

View full text Add to dashboard Cite

show abstract

“…At no point should the cyst be expanded beyond its original size. Care should be taken to ensure that the needle tip remains within the cyst during the whole procedure to avoid injury to the pancreatic parenchyma and leaks in the cyst wall [80][81][82] . Ideally, cysts considered amenable to ablation should be benign with no malignant features, 2-4 cm in diameter, uni/oligolocular, and demonstrate no connection with the pancreatic duct.…”

Section: Eus-guided Therapymentioning

confidence: 99%

“…While promising, this procedure is still being studied as concerns about remnant premalignant epithelium, unclear effects on the natural history of cysts, and uncertainty over long term monitoring and outcomes remain [9,78,82] .…”

Section: Eus-guided Therapymentioning

confidence: 99%

Endosonography in the diagnosis and management of pancreatic cysts

Kadiyala

Lee

2015

WJGE

View full text Add to dashboard Cite

Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying risk of malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound (EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration (FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUS-FNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUS-guided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.

show abstract