4547 A novel endoscopic ultrasound guided fine needle aspiration technique for the diagnosis of malignant cystic lesions of the pancreas.

Abstract

Background: Preliminary studies using EUS-guided FNA of pancreatic cyst fluid suggest a potential role for this modality in diagnosing premalignant/malignant lesions. However, the precise technique of EUS-guided FNA, for cystic lesions with a solid component has not been described. Methods: 42 pancreatic cystic lesions underwent EUS-guided FNA using the Olympus GF-UM30P or Pentax FG-32UA/36UX linear array echoendoscope and a 22-gauge needle (Mediglobe, Olympus or Wilson- Cook). The needle was advanced under EUS guidance into the cyst in the direction of the solid component and aspirated completely. Then without withdrawal, the needle was advanced directly into the solid component. Fluid/solid cytology were analyzed separately. All patients received antibiotics. Results: 12 of the 42 cysts were found to have a solid component (See Table). 9 patients had benign fluid/solid cytology. 1 patient had malignant fluid/solid cytology. 3 patients had benign fluid but malignant (c/w cystadenocarcinoma) solid cytology. Conclusions: EUS-guided FNA of the solid component of pancreatic cysts may increase the cytologic diagnosis of malignant lesions. Background: Preliminary studies using EUS-guided FNA of pancreatic cyst fluid suggest a potential role for this modality in diagnosing premalignant/malignant lesions. However, the precise technique of EUS-guided FNA, for cystic lesions with a solid component has not been described. Methods: 42 pancreatic cystic lesions underwent EUS-guided FNA using the Olympus GF-UM30P or Pentax FG-32UA/36UX linear array echoendoscope and a 22-gauge needle (Mediglobe, Olympus or Wilson- Cook). The needle was advanced under EUS guidance into the cyst in the direction of the solid component and aspirated completely. Then without withdrawal, the needle was advanced directly into the solid component. Fluid/solid cytology were analyzed separately. All patients received antibiotics. Results: 12 of the 42 cysts were found to have a solid component (See Table). 9 patients had benign fluid/solid cytology. 1 patient had malignant fluid/solid cytology. 3 patients had benign fluid but malignant (c/w cystadenocarcinoma) solid cytology. Conclusions: EUS-guided FNA of the solid component of pancreatic cysts may increase the cytologic diagnosis of malignant lesions.