Mo1442 Pancreatic Cystic Lesions Referred for Surgery Based on EUS Criteria: Correlation With Surgical Pathology

Abstract

The objective of this study is to determine how often EUS and EUS-FNA changed management of these lesions. Methods: Four gastroenterologists and four surgeons from 4 tertiary hospitals were asked to independently report their diagnosis and management recommendations of 49 patients with PCL at three different levels of information: 1. clinical and CT findings 2. EUS findings 3. result of EUS -FNA ( cytology and biochemistry) . Results: Cystic lesions that were studied were: IPMT (41.9%), mucinous cystadenoma (22.5% ), serous cystadenoma ( 11.7%), pseudocyst (10 %), neuroendocrine (2.3% ) tumor, cyst nonspecific (11.6%). Gold standard was surgical specimen or follow up and cytology . The results of EUS induced a change in the diagnosis and management in 32 % and 20% of cases respectively. The change was towards a more interventionist attitude (for example from surveillance to surgery) in 50% of cases. EUS-FNA caused a change in the diagnosis and management of 41 % and 21 % of cases respectively. Agreement between specialists was low for diagnosis and treatment (kappaZ0,32 and 0,21 respectively); diagnosis agreement improved with EUS-FNA additional information (KappaZ0,43). Among specialists, agreement was greater for gastroenterologist (step 1: 0,47; step 2: 047; step 3: 0,51) than surgeons (Step 1: 0,21; step 2: 0,35; step 3: 0,39). Conclusion: EUS and EUSFNA have a significant impact on the management of pancreatic cystic lesions . The agreement between specialists is low, but increases with the result of FNA.