Fluid CEA Levels Research Articles

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion.

Epidermal growth factor receptor (EGFR) mutation is important in determining the treatment strategy for advanced lung cancer patients with malignant pleural effusion (MPE). Contrary to serum carcinoembryonic antigen (S-CEA) levels, the associations between pleural fluid CEA (PF-CEA) levels and EGFR mutation status as well as between PF-CEA levels and treatment efficacy have rarely been investigated in lung adenocarcinoma patients with MPE. This retrospective study enrolled lung adenocarcinoma patients with MPE and available PF-CEA levels and EGFR mutation results. The patients were categorized based on PF-CEA levels: < 10 ng/mL, 10-100 ng/mL, 100-500 ng/mL, and ≥ 500 ng/mL. The association between PF-CEA levels and EGFR mutation status as well as their therapeutic impact on overall survival was compared among the four groups. This study included 188 patients. PF-CEA level was found to be an independent predictor of EGFR mutation but not S-CEA level. The EGFR mutation rates were higher as the PF-CEA levels increased, regardless of cytology results or sample types. Among EGFR-mutant lung adenocarcinoma patients receiving EGFR-tyrosine kinase inhibitor (TKI) treatment, those with high PF-CEA levels had significantly better survival outcomes than those with low PF-CEA levels. High PF-CEA levels were associated with high EGFR mutation rate and may lead to a favorable clinical outcome of EGFR-TKI treatment in EGFR-mutant lung adenocarcinoma patients with MPE. These findings highlight the importance of actively investigating EGFR mutation detection in patients with suspected MPE and elevated PF-CEA levels despite negative cytology results.

Mucinous Cystic Lesions of the Pancreas an EUS-FNA-based Study with ClinicoPathological Follow Up

Background: Mucinous cystic lesions of pancreas harbor a pre-malignant potential thus necessitating their distinction from the non-mucinous ones. To make this distinction, EUS-FNA cytology along with cyst fluid CEA and amylase levels are utilized in addition to endoscopic and radiological findings. Evaluation of K-ras mutations has emerged as a useful adjunct for the evaluation of mucinous cystic neoplasms of the pancreas. Aim: We aimed to study mucinous cystic lesions of the pancreas diagnosed on EUS-FNA cytology, in conjunction with cyst fluid CEA and amylase levels and the frequency of K-ras mutation in a cohort of patients seen at the largest cancer hospital in our country. Materials and Methods: After approval from the institutional review board, all the cases of mucinous cystic lesions of pancreas evaluated between July 2005 and August 2019 were reviewed. Patient data, including age, gender, endoscopic and radiological findings, cytological and/or histological diagnosis, cyst fluid CEA, and amylase levels were collected. Results: Twenty-three patients enrolled in the study demonstrated an equal gender distribution with a mean age of 67.4 years. The sensitivity of EUS-FNA for mucinous cystic lesions of the pancreas was 84.6%. Cyst fluid CEA levels were elevated in some MCNs but not IPMNs resulting in a sensitivity of 37.5%. The specificity of cyst fluid amylase was 90%. K-ras mutation was found to have a sensitivity and specificity of 50% and 100% respectively, for mucinous lesions of the pancreas. Conclusion: EUS-FNA is a useful technique for evaluation of pancreatic cystic lesions, especially since cytological diagnosis can be augmented by cyst fluid CEA and amylase levels. K-ras analysis can add further to the diagnostic utility of EUS-FNA

Evaluation of Diagnostic Yield of K-RAS Mutation and Cystic Fluid CEA Level in Pancreatic Mucinous Cysts

Evaluation of Diagnostic Yield of K-RAS Mutation and Cystic Fluid CEA Level in Pancreatic Mucinous Cysts

Elevated Fluid CEA levels in a Pancreatic Lymphoepithelial Cyst

Elevated Fluid CEA levels in a Pancreatic Lymphoepithelial Cyst

Su1461 Epidemiology of Solid Pseudopapillary Neoplasm in the United States

which can classify the cyst samples. Results: Sixty nine patients who underwent EUS-FNA (median age 66, range 20-90 years, including 32 males) with PCs ranging in size from 780 mm (median 18 mm) were included in the analysis. Median fluid CEA level was 144 ng/ml (range 0.2-392310). Mucinous lesions were diagnosed in 30 and non-mucinous in 39 patients. A total of 101 miRNAs were differentially expressed in mucinous cysts, out of which only 11 have been previously reported in literature to be overexpressed in mucinous PCs and/or pancreas cancer (mi10b, 181a, 212, 26a, 30a, 194, 200c, 200b, 99b, 192, and 31). Out of 101, 36 unique miRNAs were found to be overexpressed based on detectable expression in at least 50% of the lesions aspirated. Table 1 and Figure 1 depict the differential expression in the top group of miRNAs assessed. Conclusion: EUS-FNA is a reliable method for PC fluid acquisition and does not appear to affect the ability to profile miRNAs in the fluid. We report on a larger cohort of miRNAs differentially expressed in mucinous PCs than previously described. Further validation of our findings is warranted.

Low interobserver agreement in cytology grading of mucinous pancreatic neoplasms.

Identifying high-grade features in patients with pancreatic mucinous neoplasms (MNs) is important for patient management. The reproducibility of MN cytology grading has been evaluated to a limited extent. In the current study, the authors evaluated interobserver variability in grading MNs and the identification of neoplastic mucin in endoscopic ultrasound-guided fine-needle aspiration specimens. A 54-case grading set was created from histologically confirmed MNs (44 MNs) and nonmucinous lesions with abundant gastrointestinal contamination (10 nonmucinous lesions). Six observers received a tutorial, reviewed prescreened slides, and recorded: 1) a diagnosis according to a 6-tiered system (TS) (nondiagnostic, atypical [ATP], mucinous cyst low grade [MCLG], mucinous cyst high grade, suspicious for adenocarcinoma, and positive for adenocarcinoma); 2) the cyst fluid carcinoembryonic antigen diagnosis (CEADX); and 3) the presence of neoplastic musin. Interobserver agreement (IOA) was evaluated by calculation of kappa coefficients (Kappa). Diagnostic accuracy was not evaluated. The IOA was lowest for the 6-TS (Kappa, 0.13; P<.001). The CEADX was available for 18 cases (33%), including 6 of 24 MCLG cases (25%). CEADX modestly improved IOA for combined tiers of the 6-TS with ATP and MCLG as separate categories. The highest IOA was noted with a 3-TS (nondiagnostic, ATP/MCLG, and mucinous cyst high grade/suspicious for adenocarcinoma/positive for adenocarcinoma [Kappa, 0.28; P<.001]) and various 4-TS (Kappa, 0.22-0.23). IOA was found to be low for neoplastic mucin (Kappa = 0.15; P<.001). In a study using simulated cytology practice, observers demonstrated fair IOA for grading MNs and low IOA for identifying neoplastic mucin. Knowledge of the cyst fluid CEA level was found to modestly improve the IOA for low-grade lesions.

Increase in Branched Duct IPMN Lesion Size During Surveillance Is Not Associated With Other High-Risk Features: A Multi-Center Study

Introduction: Branched duct intraductal papillary mucinous neoplasms (BD-IPMNs) are the most common type of incidental pancreatic cysts. Cyst growth on follow-up imaging remains a concerning sign and usually prompts more rigorous surveillance or surgical resection. The significance of size changes of BD-IPMNs over time remains unclear. The aim of this study is to find predictors of cyst growth and whether rapid cyst growth is associated with increased risk of malignancy. Methods: This is a retrospective study of BD-IPMN patients managed at 2 high-volume referral centers. Patients were included if they were followed for more than 6 months and underwent pancreatic imaging at least twice. Cyst size on imaging studies was calculated by averaging the major and minor axis dimensions. Mean cyst growth rate percentage (MGRP) was calculated as: (final size − initial size)/(initial size)*(100/years) in order to reflect initial cyst size. Rapid cyst growth was defined as a mean cyst growth rate percentage (MGRP) ≥20% per year. Results: Between 1996 and 2013, 326 patients were diagnosed with BD-IPMNs; 168 met inclusion criteria and were followed for a median of 24 months (range: 6.1-114.5 months). Mean age was 64.7±12.1 years; 101 (60.1%) were men. Mean cyst size at baseline (MCSB) was 15.72±9.3 mm. During follow- up, 76 (45.2%) showed an increase in size, of which 27 cysts (35.5%) exhibited rapid growth, with MGRP ≥20% per year occurring in older patients (68.89 years vs. 63.88 years; p=0.04). Rapid cyst growth was not associated with family history of pancreatic disease, smoking, alcohol intake, development of interval symptoms, and cyst characteristics such as baseline size, multiplicity, location, presence of mural nodules or septae, and mean cyst fluid CEA level (4407.6 ng/mL vs. 1863.2 ng/mL; p=0.28). Cyst fluid from 107 cysts was sent for DNA analysis and showed K-ras mutations in 27. Compared to K-ras negative cysts neither MCSB (16.59 mm vs. 17.83 mm) nor MGRP (6.53% per year vs. 3.71% per year) was significantly different. Similar results were observed in cysts with high DNA levels (≥40 ng/uL) or ≥2 allelic imbalance mutations. Eighteen patients underwent surgery during follow-up; 15 (83.3%) patients had low-grade dysplasia (LGD), and 3 had advanced neoplasia (1 high-grade dysplasia and 2 with invasive carcinoma). None of the 3 cysts with advanced neoplasia had MGRP ≥20% per year. Conclusion: BD-IPMNs grow in a significant proportion of patients. However, a significant increase in cyst size was not associated with other high-risk patient or cyst characteristics. Cyst fluid tumor markers do not predict which lesions are likely to grow rapidly. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.

Epidermoid Cyst of Intrapancreatic Accessory Spleen: A Diagnostic Dilemma

Introduction: Epidermoid cyst of intrapancreatic accessory spleen (IPAS) is a rare diagnosis with only 32 cases reported in the literature. We present the case of a 39-year-old male who underwent distal pancreatectomy for presumed intraductal pancreatic mucinous neoplasm (IPMN) that was diagnosed to be an epidermoid cyst of IPAS. Case Report: A 39-year-old male with history of alcohol abuse was admitted to the hospital with complaints of abdominal pain, nausea, vomiting, and intermittent hematochezia associated with weight loss of 20 pounds in 2 months. Abdominal CT scan showed a 2 x 1.9 cm, well-circumscribed cystic mass in the pancreatic tail (Figure 1). Endoscopic ultrasound (EUS) also showed a cystic lesion in pancreatic tail (Figure 1). Fine needle aspiration cytology (FNA) revealed a few “atypical” cells with intra- and extracellular mucin. Cyst fluid CEA level of 10,460 ng/mL was noted, concerning for a mucinous neoplasm. The patient underwent distal pancreatectomy and splenectomy. However, pathology revealed epidermoid cyst of intrapancreatic accessory (heterotopic) spleen with low-grade pancreatic intraepithelial neoplasia.Figure 1Discussion: Epidermoid cyst of IPAS was first reported by Davidson et al in 1980. It is believed that some unidentified genetic and/or environmental factors might play a role in its development as most of these cases have been reported from the Asian community. It is commonly found in adults in the age group 40-70 years and does not seem to carry any gender predilection. Clinically, patient is asymptomatic, and the lesions in found incidentally on abdominal imaging. It can easily mimic other pancreatic lesions including premalignant lesions like IPMN and mucinous cysts, as was the case in our patient. CT, MRI, and EUS-FNA are helpful but it can be difficult to establish an accurate diagnosis without gross pathology from a resected specimen obtained surgically. Epidermoid cyst of IPAS is a rare entity, but should be kept in mind in the differential diagnosis of cystic pancreatic lesions, particularly as it carries an excellent prognosis. Conclusion: Epidermoid cyst of IPAS is a benign lesion found incidentally on abdominal imaging and is difficult to diagnose without pathology obtained from surgical resection. It is a benign entity and patients should be reassured about the good prognosis. This is the fifth reported case of such a lesion from the western part of the world.

Tu1921 RBP-J Gene May Be Associated With Bone Mineral Density of IBD Patients

macrocystic or microcystic morphology, and impression of a pseudocyst] were noted. FNA results, including cyst fluid CEA , and cytology features of mucin, cellular atypia or cancer were recorded. Univariate analysis (Fisher's exact and Mann-Whitney U test) was performed followed by multivariate logistic regression analysis to identify if CEA was an independent predictor for MCN. ROC curves were generated for CEA levels to evaluate its diagnostic characteristics. Results: 2407 pts met inclusion criteria and 1861 (77.6%) underwent EUSFNA [mean age 63 yrs, 87% Caucasians, 58% females, and mean pancreatic cyst size 26 mm]. 376 pts underwent surgery (37% Whipple's surgery, 45% distal pancreatectomy, 18% others) and cancer on cytology was noted in 138 pts. Based on the gold standard, there were 440 pts with MCN (including IPMN) and 882 NMCN. On univariate analysis, the median values of CEA in MCN were significantly higher than that of NMCN (126.9 vs. 21.65, p < 0.001). On multivariate analysis, CEA [OR = 1.3 (1.1 1.6), p < 0.01] was a statistically significant predictor for MCN while adjusting for mucin on cytology, presence of solid mass on EUS, mural nodule, and multilocularity. Area under ROC curve was 0.74 (0.70 0.77, p<0.01) for CEA (cut off of 92.9 ng/ml sensitivity, 70% and specificity, 64%) (Figure). The traditional cut off of 192 ng/ml yielded a sensitivity of 59% and specificity of 73% in identifying MCN. Conclusions: This large multicenter study demonstrates that cyst fluid CEA levels have an unacceptable accuracy level in differentiating MCN and NMCN of the pancreas limiting its applicability in clinical practice. Future studies should focus on novel markers in cyst fluid to improve the risk stratification for diagnosis, cancer risk and surveillance of pancreatic cystic neoplasms. Table: AUC, Sensitivity and specificity of CEA in differentiating MCN from NMCN.

Tu1920 The Role of Genetic Variation and C-Reactive Protein (CRP) in IBD

macrocystic or microcystic morphology, and impression of a pseudocyst] were noted. FNA results, including cyst fluid CEA , and cytology features of mucin, cellular atypia or cancer were recorded. Univariate analysis (Fisher's exact and Mann-Whitney U test) was performed followed by multivariate logistic regression analysis to identify if CEA was an independent predictor for MCN. ROC curves were generated for CEA levels to evaluate its diagnostic characteristics. Results: 2407 pts met inclusion criteria and 1861 (77.6%) underwent EUSFNA [mean age 63 yrs, 87% Caucasians, 58% females, and mean pancreatic cyst size 26 mm]. 376 pts underwent surgery (37% Whipple's surgery, 45% distal pancreatectomy, 18% others) and cancer on cytology was noted in 138 pts. Based on the gold standard, there were 440 pts with MCN (including IPMN) and 882 NMCN. On univariate analysis, the median values of CEA in MCN were significantly higher than that of NMCN (126.9 vs. 21.65, p < 0.001). On multivariate analysis, CEA [OR = 1.3 (1.1 1.6), p < 0.01] was a statistically significant predictor for MCN while adjusting for mucin on cytology, presence of solid mass on EUS, mural nodule, and multilocularity. Area under ROC curve was 0.74 (0.70 0.77, p<0.01) for CEA (cut off of 92.9 ng/ml sensitivity, 70% and specificity, 64%) (Figure). The traditional cut off of 192 ng/ml yielded a sensitivity of 59% and specificity of 73% in identifying MCN. Conclusions: This large multicenter study demonstrates that cyst fluid CEA levels have an unacceptable accuracy level in differentiating MCN and NMCN of the pancreas limiting its applicability in clinical practice. Future studies should focus on novel markers in cyst fluid to improve the risk stratification for diagnosis, cancer risk and surveillance of pancreatic cystic neoplasms. Table: AUC, Sensitivity and specificity of CEA in differentiating MCN from NMCN.

Surgical management and results for cystic neoplasms of pancreas.

Backgrounds/AimsThe diagnosis for cystic neoplasm of pancreas is based on the morphologic criteria through imaging studies, but the pre- and postoperative diagnoses are often inconsistent. This study aims at the analysis of clinical characteristics and the results of surgical treatments.MethodsA retrospective review was performed on 93 patients who have undergone surgery for pancreatic cystic diseases in our hospital from January 2001 to February 2013. Among them, 69 patients were confirmed as cystic neoplasms based on pathologic findings. Their clinical manifestations, diagnostic accuracy, surgical method and complications, pathologic findings were analyzed.ResultsSerous cystic neoplasm was the most common (n=22), followed by mucinous cystic neoplasm (n=18), intraductal papillary mucinous tumor (n=11), solid pseudopapillary tumor (n=9), neuroendocrine tumor (n=7), and cystic lymphangioma (n=2). The most common clinical symptom is abdominal pains (49.3%). Preoperative imaging studies were consistent with pathological findings in 72% of patients. Cystic fluid CEA levels of 400 ng/ml or more were reliable to detect mucin secreting tumors. Pancreatoduodenectomy was performed for 13 cases and the remaining 54 patients were treated with left-side pancreatectomy. Malignancy was found in 9 cases (13%) of mucin secreting tumors; 5 cases (27.8%) in mucinous cystic neoplasm and 4 cases (36.4%) in intraductal papillary mucinous tumor. Two of these survived without recurrences during the follow-up periods.ConclusionsExact treatment protocols for cystic neoplasm of pancreas are not decided because tumors are found with atypical forms. Surgical management is suggested for resectable tumors because a good prognosis can be expected with proper surgery if precancerous lesions are suspected at the time of discovery.

Does Cyst Fluid CEA Level Correlate with Malignancy Potential in Mucinous Cystic Lesions of the Pancreas?

Purpose: To determine if cyst fluid CEA can be used to differentiate between benign and malignant cystic neoplasms of the pancreas. Methods: A retrospective case control study was conducted; all mucinous pancreatic cystic lesions that have been surgically resected at one institution from January 1, 2000, to June 1, 2008, were identified and reviewed. Information on cyst fluid CEA level was retrospectively gathered. Results: A total of 123 mucinous cystic lesions of the pancreas were resected at the Hospital of the University of Pennsylvania within this time frame. Of these, 91 patients underwent endoscopic ultrasound (EUS) evaluation prior to surgical resection. Of these, 30 patients had cyst fluid CEA evaluated. Table 1 describes cyst fluid CEA level by lesion type. There was no significant association identified between CEA level (per 1000 unit increase) and aggressive behavior of the lesion, defined as moderate dysplasia or higher (OR 1.004, 95% CI 0.974-1.035).Table: ResultsConclusion: While cyst CEA level can be used to differentiate between mucinous and non-mucinous cystic lesions of the pancreas, it does not allow the clinician to determine malignancy potential of mucinous cystic lesions of the pancreas.

Fluid analysis prior to surgical resection of suspected mucinous pancreatic cysts. A single centre experience.

EUS-FNA cytology and fluid analysis are frequently utilized to evaluate pancreatic cysts. Elevated cyst fluid CEA is usually indicative of a mucinous pancreatic cyst but whether CEA or amylase values can subclassify various mucinous cysts is unknown. The purpose of this study is to determine whether cyst fluid CEA and amylase obtained by EUS-FNA can differentiate between mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). Using our prospective hospital EUS and surgical databases, we identified all patients who underwent EUS of a pancreatic cyst prior to surgical resection, in the last 10 years. Cysts were pathologically sub-classified as MCNs or IPMNs; all other cysts were considered non-mucinous. Values of cyst fluid CEA and amylase were correlated to corresponding surgical histopathology and compared between the two groups. 134 patients underwent surgery for pancreatic cysts including 82 (63%) that also had preoperative EUS. EUS-FNA was performed in 61/82 (74%) and cyst fluid analysis in 35/61 (57%) including CEA and amylase in 35 and 33 patients, respectively. Histopathology in these 35 cysts demonstrated nonmucinous cysts in 10 and mucinous cysts in 25 including: MCNs (n=9) and IPMNs (n=16). Cyst fluid CEA (p=0.19) and amylase (p=0.64) between all IPMNs and MCNs were similar. Between branched duct IPMNs and MCNs alone, cyst fluid CEA (p=0.34) and amylase (p=0.92) were also similar. In this single center study, pancreatic cyst fluid amylase and CEA levels appeared to be of limited value to influence the differential of mucinous pancreatic cysts. Larger studies are recommended to evaluate this role further.

S1305 Does Fluid CEA Level Predict Malignancy in Intraductal Papillary Mucinous Neoplasms (IPMNs)?

S1305 Does Fluid CEA Level Predict Malignancy in Intraductal Papillary Mucinous Neoplasms (IPMNs)?

EUS-Guided Ethanol Lavage with Paclitaxel Injection (EUS-EP) for Cystic Tumors of the Pancreas (CTP): Long-Term (More Than One Year) Follow-Up

Background: EUS-guided intervention has been recently tried for the treatment of CTP. Preliminary reports showed the safety and feasibility of EUS-guided intervention. Treatment responses were also somewhat promising, but differed among studies as previous studies involved small number of patients and short-term follow-up. Its effectiveness, therefore, should be evaluated by the study with larger population and longer follow-up. The present study analyzed the treatment response of EUS-EP over longer period among larger study population, and factors which may influence the treatment response. Methods: Thirty-three patients were enrolled for EUS-EP by the following inclusion criteria; 1) uni- or oligolocular CTP, 2) indeterminate tumors for which EUS-FNA was required, and 3) CTPs showing size growth during the observation period. Under EUS-guidance, cyst fluid aspiration, ethanol lavage and injection of paclitaxel were performed. The safety of EUS-EP was analyzed by monitoring the patients till the first 30 days. Twenty-nine patients were followed for > 12 months, and the treatment response and its predictors were analyzed. Using CT images, the volume CTP was calculated by computer estimations of the areas on each axial image and slice thickness. Response is defined as follows; 1) complete resolution (CR): < 5% of original volume (OV), 2) partial resolution (PR): 5 to 25% of OV, 3) persistent cyst: > 25% of OV. Results: Mean diameter and volume were 30.1 mm (17-68 mm) and 11.64 mL (1.16-68.74 mL), respectively. Twelve tumors were oligolocular. Mean CEA level was 535.1 ng/mL (1-8190). The presumed diagnoses were 5 MCNs, 5 SCAs, 1 pseudocyst and 18 indeterminate cysts. The median follow-up was 16.8 months. CR was observed in 22 patients, PR in 5 patients, and a cyst persisted in 2 patients. Five patients with PR showed gradual decrease in volume (6-10% of OV). The resected specimens of two persistent tumors, which were oligolocular, revealed focal remnant mucinous epithelial lining. The original volume was significantly different between CR and persistent group, whereas there was no difference in presence of septation and cyst fluid CEA level. CR was achieved within 6 months (early) in 8 patients and after 6 months (late) in 13 patients. CEA level was significantly higher in late CR group than early group. Mild pancreatitis was observed in one patient. Conclusions: EUS-EP appears to be a safe and effective method for treating CTP. CR seems to be better achieved in smaller tumors than larger ones. Tailored intervention for septated tumors and additional therapy for tumors with high CEA may be needed to minimize missed locules and maximize ablation effect.

Therapeutic Success of Endoscopic Ultrasound-Guided Drainage of Pancreatic Pseudocysts in a Pediatric Population

Background: Endoscopic drainage has become established as the primary therapy for pancreatic pseudocysts (PC) in adults. Endoscopic ultrasound (EUS) has improved the safety and efficacy of transmural drainage by identification of blood vessels, wall thickness and most optimal site for cyst puncture. However, the management of symptomatic PC among children is less clear regarding the role of EUS. Aim: The aim of this study was to evaluate the success and safety of linear EUS-guided drainage of symptomatic pancreatic PC in children. Methods: Children who presented to our institution between 1/2004 and 8/2008 with symptomatic PC were included. All patients had pancreatic cysts noted on CT imaging. EUS was performed with the curvilinear array Olympus endoscope (GFUC140-P or GFUCT140) and either 19- or 22-guage Cook aspiration needles. Antibiotic prophylaxis was administered prior to endoscopy. PC was confirmed by the appearance on CT and/or EUS, fluid aspiration with histology and in certain cases elevated fluid amylase and low fluid CEA levels. Complete aspiration of smaller cysts was attempted. In other cysts, one to two 10 Fr double pig-tailed plastic stents were placed for 8 weeks and removed after resolution of the PC. Results: The group included 9 patients age <18years (4-17years), (6 females, 3 males). Etiologies of pancreatitis and PC included biliary stones (2), trauma (2), idiopathic (3), familial (1), and divisum (1). Indications for therapy included fever (2), pain (5) and impaired oral intake (2). In the initial cases, EUS served as a salvage therapy for failed ERCP (2), then a combined modality (2), and finally the primary modality to treat pancreatic cysts (5). Cysts larger than 5 cm required EUS-guided cyst-gastrostomy with placement of transmural stents while smaller cysts could be successfully aspirated alone. One patient (familial pancreatitis) had initial success with cyst drainage but developed a second PC during recurrent pancreatitis 8 months later which necessitated surgical intervention for hemosuccus pancreaticus. The remaining 8 patients (89%) had complete resolution of symptoms without recurrence. In 3 of 9 patients, infected cysts were present and were treated successfully with EUS-guided transmural stent placement. Conclusions: EUS drainage of pancreatic PC is safe with durable symptom relief in a pediatric population. Cysts smaller than 5cm can be aspirated successfully without stent placement. Infected cysts can be managed effectively with transmural stents. This series demonstrates that the need for ERCP has diminished over time as the use of EUS-guided PC drainage has evolved into the primary modality.

Fluid CEA Level Is More Influential Than DNA Mutational Analysis in Guiding Clinical Management of Pancreatic Cystic Lesions

Fluid CEA Level Is More Influential Than DNA Mutational Analysis in Guiding Clinical Management of Pancreatic Cystic Lesions

406 DNA Mutational Analysis Versus Cytology with and Without Fluid CEA Level in the Diagnosis of Mucinous Cystic Lesions of the Pancreas: A Multicenter Study

406 DNA Mutational Analysis Versus Cytology with and Without Fluid CEA Level in the Diagnosis of Mucinous Cystic Lesions of the Pancreas: A Multicenter Study

Predicting Resolution of Pancreatic Pseudocysts After EUS-Guided Therapy Or Surgical Drainage

Background: Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is useful in diagnosing pancreatic pseudocysts and detecting infection. Complete aspiration of the pseudocyst to collapse may be therapeutic while some cases require endoscopic cyst-gastrostomy or surgical drainage. Aim: Determine the outcome of pseudocyst fluid aspiration in comparison to endoscopic or surgical cyst-gastrostomy and identify factors that predict successful resolution. Methods: Over a 24 month period, 35 consecutive pseudocysts were analyzed that presented for EUS examination. Diagnosis was confirmed by low fluid CEA, high fluid amylase, histology, and EUS features. Aspiration was performed with either a 19 or 22-guage FNA needle until the cyst collapsed. In larger volume pseudocysts, endoscopic cyst-gastrostomy by EUS-guidance was performed leaving at least one indwelling double pig-tailed 10Fr stent for six weeks. Radiographic imaging by CT and clinical follow-up were performed. Two-dimensional cyst area rather than diameter alone was reported. Results: Nine patients were lost to follow up. In 4 cases, clinical improvement was documented but no imaging was performed or available. One patient expired from multi-organ disease. The analysis included 21 patients with available follow-up CT imaging and included 12 men and 9 women, mean age of 49.6 and 57 years, respectively. 16/21 (76.1%) were noted to have resolution by endoscopic therapy. Group A included 8 patients (37.6%) who had success with single EUS-FNA aspiration alone. Group B included 4 (18.8%) who underwent successful endoscopic cyst-gastrostomy. Group C included 4 (18.8%) patients requiring surgical cyst drainage. The groups were compared for difference in size and fluid CEA and fluid amylase levels. The p values exceeded 0.5 for all comparisons. However, each group contained one patient with an infected pseudocyst which was treated successfully. Conclusion: EUS-guided endoscopic therapy was successful in treatment of 76% of pseudocysts. Interestingly, 37.6% resolved with cyst aspiration alone without requiring a cyst-gastrostomy stent. The trend suggests that higher cyst fluid amylase levels and lower cyst CEA levels correlate with the need to progress from endoscopic therapy to surgical drainage although this did not achieve statistical significance. Additionally, this study demonstrates that infected pseudocysts can be treated successfully by any of these methods. Tabled 1 GROUP Mean size cm2 Fluid CEA ng/dL Fluid amylase U/L A 18.2 187.7 46309 B 63.6 60.7 34611 C 31.3 26.7 97327 Open table in a new tab

Diagnostic Yield and Safety of Cyst Wall Puncture During EUS-Guided Fine Needle Aspiration of Pancreatic Cystic Lesions

Introduction: Endoscopic ultrasound guided fine needle aspiration is the modality of choice for preoperative diagnosis of pancreatic cystic lesions. Cyst fluid CEA and amylase levels are used to discriminate benign from neoplastic cysts. Because the diagnostic yield from cyst fluid analysis is often inadequate, modalities to sample epithelium from the cyst wall are being investigated. Needle puncture of the cyst wall for cytology is not widely practiced due to the potential risks. Aims: To determine the diagnostic yield and safety of EUS-guided cyst wall puncture for the evaluation of pancreatic cystic lesions.