Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3\xa0cm

Paula Chaves,A. Dias Pereira,Sandra Faias,João Pereira da Silva,Marília Cravo

doi:10.1186/s12876-020-01565-9

Abstract

BackgroundIn 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).ObjectiveTo evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm.MethodsRetrospective 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.ResultsWe 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.ConclusionEUS-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.

Highlights

In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features
Case selection For this single-center retrospective study, we reviewed consecutive patients with PCLs submitted to EUS between 2007 and 2016, and selected all cysts smaller than 3 cm that were further evaluated with FNA, from our Endoscopic Ultrasound database and Pancreatic Cyst Registry, as approved by the Institutional Scientific Board and Ethics Committee (UIC/1143)
Patients were divided into a surgical cohort, with definitive surgical pathology as reference standard for diagnosis, and a clinical cohort, with the diagnosis established by EUS-FNA with pancreatic cystic fluid (PCF) analysis for carcinoembryonic antigen (CEA) and/or cytology and morphologic stability after imaging surveillance for a minimum of six months

Summary

Introduction

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). Mucinous pancreatic cysts are believed to be premalignant and would represent an excellent opportunity for early diagnosis in this malignancy [1]. The key question for pancreatic cyst management is to distinguish patients harboring advanced neoplasia who should be submitted to surgery, from those with premalignant lesions who require surveillance, and those. An attempt to summarize the best available evidence for the clinical management of PCLs has been made by experts in the field with the preparation of several recent guidelines [4,5,6,7]

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Conclusion