The Diagnostic Value of the Biopsy of Small Pancreatic Cystic Neoplasmsʼ Cystic Wall by SpyGlass Through a 19-gauge Needle EUS

Abstract

Introduction: SpyGlass through EUS can be used for the diagnosis of biliopancreatic lesions. It is diffi cult to diagnose small pancreatic cystic neoplasms (PCNs) through nonsurgical methods. Biopsy of cystic wall through SpyGlass may contribute to the definitive diagnosis of small PCNs. Methods: From April 2015 to May 2016, 120 patients of small pancreatic cystic neoplasms were enrolled to perform EUS, among whom 59 patients finally received surgery. In those 120 patients who were performed EUS, 49 patients were performed SpyGlass through a 19-gauge needle EUS, and 25 of them used a biopsy forceps to obtain samples from the cystic wall. Then the samples were sent to the histopathology examination. We put a retrospective study on these 25 cases to research the diagnosis value of the biopsy of small pancreatic cystic neoplasms' Cystic wall through SpyGlass contrasting with surgical pathological diagnosis. Results: There are 6 cases which got final definitive diagnosis through pathology of the cystic wall's biopsy, and 5 cases were mucinous cystic neoplasm (MCN), 1 case was serous cystic neoplasm (MCN). Contrasting these 6 samples' diagnosis with surgical pathological diagnosis, the accuracy of the cystic wall's biopsy is 100% (MCN 100%, SCN 100%), the sensitivity is 100% (MCN 100%, SCN 100%) and the specificity is also 100% (MCN 100%, SCN 100%). 14 cases were failed to obtain samples, including inadequate samples and samples not from cystic wall. 5 cases were sectioned unsuccessfully. The total failure rate is 76%. Conclusion: Biopsy of cystic wall through SpyGlass has high accuracy, high sensitivity and high specificity for the diagnosis of small pancreatic cystic neoplasms, thus it has certain diagnostic value. But the success rate of sample obtaining and sectioning is low, therefore, it is important to elevate the accuracy of sample obtaining and the skill of section.