Tenkoihlová aspirácia pod endosonografickou kontrolou u pankreatických cystických lézií – skúsenosti z jedného centra a porovnanie s resekčnou histológiou

Abstract

Summary: Background: Pancreatic cystic lesions (PCLs) are being more frequently dia­gnosed and some have the potential for malignant transformation. The decision for performing EUS-FNA and indicating surgery remains challenging. Aims: To evaluate the feasibility and dia­gnostic yield of EUS-FNA, and in patients undergoing surgery to compare results of EUS-FNA with the resection histology. Methods: A retrospective observational study in patients undergoing EUS-FNA for PCLs. We assessed morphological risk features: solid component, a mural nodule >5 mm, dilated pancreatic duct >5 mm, lesion size >4 cm. The mucinous content was defined macroscopically by positive string test/thick mucin and/or by high CEA (>100 ng/ml) or low glucose (<2.8 mmol/l). Aspirated material was smeared and sent for cytology. Results: We included 30 patients, an M/F ratio of 20/10, with a median age of 66.5 (IQR 58–73) years. Seventeen patients had one or more risk features, 13 had none. The macroscopic evaluation of fluid was reported in 23 (76.6%) patients, it was positive in 14 (Group M) and negative in nine patients (Group N). The fluid analysis showed a presumed mucinous lesion in all patients in Group M, and four (44.4%) in Group N. Ten patients underwent surgery. Compared with resection histology, the presence of at least one risk feature had 100% sensitivity and 42.8% specificity for dia­gnosing high-grade neoplasia, the fluid analysis had 71.4% sensitivity and 66.6% specificity for a mucinous lesion, and cytological evaluation had 0% sensitivity and 66.6% specificity for high-grade neoplasia. Conclusion: Our study provides insight into the dia­gnostic complexity of PCLs. Our experience supports safe follow-up in patients without morphological risk features, and EUS-FNA indication in lesions with one or more risk features. Due to the high risk of malignancy, presumed mucinous lesions with a risk feature should be referred for surgery. Key words: pancreatic cyst – pancreatic neoplasms – endoscopic ultrasound-guided fine-needle aspiration – clinical decision-making