Mucinous Cystic Neoplasm Research Articles

Giant mucinous cystadenoma of the pancreas in a young female

Cystic tumors of the pancreas are rare and may be confused with hydatid cysts, especially in endemic areas. The incidence of cystic neoplasms of the pancreas is relatively rare in the pediatric population and young adults. We present a 21-year-old female with a well-defined giant multiloculated cystic lesion in the body and tail of the pancreas, which was diagnosed as a hydatid cyst elsewhere. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. There was no visible communication between the mucinous cystic neoplasm and the pancreatic duct. Histopathology confirmed the diagnosis of benign mucinous cystadenoma of the pancreas. Ambiguity in the management of the lesion arises when mucinous cystadenoma is commonly misdiagnosed as pancreatic pseudocyst because the surgical management is entirely different.

Identification of high-risk features in mucinous cystic neoplasms of the pancreas

BackgroundMucinous cystic neoplasms of the pancreas are uncommon tumors that have the potential of becoming cancer. There is no consensus regarding the high-risk features of these tumors. Our study aimed to identify the preoperative demographic, clinical, or radiologic factors that can predict the presence of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas. MethodsWe identified 157 patients who underwent resection and fulfilled the pathologic criteria for mucinous cystic neoplasms of the pancreas in a prospectively maintained database spanning 3 decades (1990–2020). Multivariable logistic regression was used to identify predictors of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas. ResultsThe rate of high-grade dysplasia or invasive carcinoma was 11%. Tumor size ≥4 cm (P < .001), mural nodularity (P = .04), and a serum CA 19-9 level >37 U/mL (P < .001) were associated with high-grade dysplasia or invasive carcinoma. In the multivariable analysis, tumor size ≥4 cm (odds ratio 16.9, 95% confidence interval 2.04–140, P = .009) and a CA 19-9 level >37 U/mL (odds ratio 5.68, 95% confidence interval 1.52–21.3, P = .010) were predictors of high-grade dysplasia or invasive carcinoma. There were no tumors with high-grade dysplasia or invasive carcinoma in patients with tumor size <4 cm in the absence of an elevated CA 19-9 or mural nodularity. ConclusionTumors with a size ≥4 cm and/or a high CA 19-9 level should be considered for prompt surgical resection. Conversely, tumors <4 cm with no other high-risk features have a negligible risk for high-grade dysplasia or invasive carcinoma and may benefit from nonoperative surveillance. Mural nodularity is an additional suspicious feature. These findings may contribute to future guidelines.

Epigenetic reprogramming in pancreatic premalignancy and clinical implications.

Pancreatic cancer (PC) is the most lethal human cancer, with less than 10% 5-year survival. Pancreatic premalignancy is a genetic and epigenomic disease and is linked to PC initiation. Pancreatic premalignant lesions include pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), and mucinous cystic neoplasm (MCN), with pancreatic acinar-to-ductal metaplasia (ADM) as the major source of pancreatic premalignant lesions. Emerging evidence reveals that an epigenetic dysregulation is an early event in pancreatic tumorigenesis. The molecular mechanisms of epigenetic inheritance include chromatin remodeling; modifications in histone, DNA, and RNA; non-coding RNA expression; and alternative splicing of RNA. Changes in those epigenetic modifications contribute to the most notable alterations in chromatin structure and promoter accessibility, thus leading to the silence of tumor suppressor genes and/or activation of oncogenes. The expression profiles of various epigenetic molecules provide a promising opportunity for biomarker development for early diagnosis of PC and novel targeted treatment strategies. However, how the alterations in epigenetic regulatory machinery regulate epigenetic reprogramming in pancreatic premalignant lesions and the different stages of their initiation needs further investigation. This review will summarize the current knowledge of epigenetic reprogramming in pancreatic premalignant initiation and progression, and its clinical applications as detection and diagnostic biomarkers and therapeutic targets in PC.

Lymphoepithelial cyst of the pancreas: can common imaging features help to avoid resection?

BackgroundDifferentiation of cystic pancreatic neoplasms remains a challenging task for radiologists regarding the main aim of identifying malignant and premalignant lesions.PurposeThe study aimed to compare the radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection.Material and methodsWe retrospectively reviewed 10 cases of resected and histopathologically confirmed LECs during a 12-year period with available imaging studies; 20 patients with mucinous cystic neoplasms (MCN), 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN), and 20 patients with serous cystic neoplasms (SCN) were selected to serve as control groups. Imaging findings as well as clinical data were analyzed.ResultsThe following imaging morphology of LEC was identified: simple cystic appearance (20%) and mixed cystic-solid appearance (80%) with either a diffuse subsolid component (30%) or mural nodule(s) (50%). All lesions revealed exophytic location with a strong male predominance (9:1). MCNs occurred exclusively in middle-aged women, IPMN in both sexes showed slight male predominance (13:7), and SCN showed female predominance (5:15). Median patient age in LEC (48.5, IQR 47–54.5) was significantly younger compared to IPMN (p < 0.001) and SCN (p = 0.02). Unenhanced CT attenuation of LEC was higher than MCNs (p = 0.025) and IPMNs (p = 0.021), showing no significant difference to SCN (p = 0.343).ConclusionThe present study provides key radiological features of LEC for the differentiation from other cystic pancreatic lesions such as increased CT attenuation in the unenhanced phase, absence of a connection to the main pancreatic duct (MPD), and exophytic location. In addition to these imaging features, clinical data, such as male predominance in LEC, must be considered for the differentiation of cystic pancreatic lesions.

A Ruptured Mucinous Cystadenocarcinoma of the Pancreas Extensively Evaluated Before and After the Rupture: A Case Report.

Pancreatic mucinous cystic neoplasm (MCN) rarely ruptures because of their surrounding fibrotic capsules and has never been reported with detailed information regarding prerupture and postrupture states. We report a case of MCN rupture where performed emergency surgery was performed while waiting for elective surgery. A 54-year-old woman was referred to our department for a pancreatic cystic tumor with slight abdominal pain. A cystic tumor with a nodular lesion was found, with a contrast effect measuring 78 mm in diameter. On day 21, the patient visited our hospital complaining of increased abdominal pain, but few signs of peritonitis were observed. Tests conducted revealed moderate ascites, marginal shrinkage of the cyst diameter, and a slight elevation of inflammatory markers. We suspected an MCN rupture and immediately performed distal pancreatectomy. Brown turbid ascites and rupture of the anterior wall of the cyst were observed. In the ascites, amylase levels were not elevated, and bacterial cultures were negative. The histopathological diagnosis was noninvasive mucinous cystadenocarcinoma. At 9 months after surgery, she started chemotherapy because of a recurrence of the peritoneal dissemination. This case provided valuable insight into the rupture of MCNs using thorough imaging techniques, laboratory, and physical findings before and after rupturing.

Ten years of experience in patients with resected pancreatic tumors: Real-world data in a public institution in Peru.

686 Background: In Peru, the incidence of pancreatic tumors is 3.59 per 100,000 inhabitants, being the ninth cause of death. The standard of treatment in the world is surgery, achieved in 13% of patients, with overall survival (OS) and disease-free survival (PFS) at 5 years of 10% and 34%, respectively. In our study, the different subtypes of pancreatic tumors that were resected by surgery, their clinical/pathological characteristics, OS and PFS were evaluated. Methods: A retrospective review was carried out, in patients older than 18 years, diagnosed and treated with first intention surgery, during 2010 - 2019. 36.9% were adenocarcinoma (AD), 36.2% solid pseudopapillary neoplasm, 20.6% serous cystadenoma, 3.5% intraductal papillary mucinous neoplasm, 2.1% mucinous cystic neoplasm, and 0.7% acinar cell carcinoma. The Kaplan Meir method was used to estimate OS and PFS, and the log-rank test to differentiate between estimated curves. Results: 141 patients with resected pancreatic tumors; 73.8% without comorbidities and 2.1% with Diabetes Mellitus. Jaundice at debut was present in 22.7%, of whom 60% were AD; with OS at 5 years, 23.7% of patients with jaundice vs 69.9% without jaundice, 55.3% of tumors were located in the head of pancreas, 78.8% were AD; an OS at 5 years of 50.1% vs 67.3% of not located in the head of the pancreas. According to staging (S), 14.2% S I, 43.3% S IIA, 20.6% S IIB, and 22% S III; 100% were AD in S IIB-III vs 8.9% non-AD, with OS at 5 years S III of 16.2% and IIB of 39.3%. OS and PFS at 5 years, in pancreatic tumors were 57.7% and 73.5%, respectively. For patients with AD, the OS and PFS were 22.9% and 36.9%, respectively. Conclusions: The study suggests that jaundice at debut, located in head of the pancreas, S IIB-III, are worse prognostic factor in our patients with pancreatic tumors, especially in AD. And our patients with resected AD, presents greater survival compared to literature, although more evidence is still required due to the type of study.

Pancreatic Cystic Tumors: A Single-Center Observational Study.

Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and Methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014-2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n = 124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40-79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22-55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6-10 cm) and the mean size of MCNs was the largest 6.78 (1.5-19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient's age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery.

CT classification model of pancreatic serous cystic neoplasm and mucinous cystic neoplasm based on deep transfer learning.

Pancreatic cancer is a highly lethal disease. The preoperative distinction between pancreatic serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN) remains a clinical challenge. The goal of this study is to provide clinicians with supportive advice and avoid overtreatment by constructing a convolutional neural network (CNN) classifier to automatically identify pancreatic cancer using computed tomography (CT) images. We construct a CNN model using a dataset of 6,173 CT images obtained from 107 pathologically confirmed pancreatic cancer patients at Shanghai Changhai Hospital from January 2017 to February 2022. We divide CT slices into three categories namely, SCN, MCN, and no tumor, to train the DenseNet201-based CNN model with multi-head spatial attention mechanism (MSAM-DenseNet201). The attention module enhances the network's attention to local features and effectively improves the network performance. The trained model is applied to process all CT image slices and finally realize the two categories classification of MCN and SCN patients through a joint voting strategy. Using a 10-fold cross validation method, this new MSAM-DenseNet201 model achieves a classification accuracy of 92.52%, a precision of 92.16%, a sensitivity of 92.16%, and a specificity of 92.86%, respectively. This study demonstrates the feasibility of using a deep learning network or classification model to help diagnose MCN and SCN cases. This, the new method has great potential for developing new computer-aided diagnosis systems and applying in future clinical practice.

Urachal mucinous cystic neoplasm of low malignant potential – a rare entity

Mucinous cystic neoplasms of the urachus are exceedingly rare, yet likely under recognised tumours with a morphological spectrum of malignancy similar to mucinous ovarian neoplasms. We report a case of a urachal cyst identified incidentally in an otherwise well 35-year-old man. Radiologically and macroscopically, the cyst was intact, unilocular, and filled with copious mucin. It had a smooth inner surface and no patent luminal continuity with the urinary bladder. Histologically, the cyst wall comprised a single layer of mucinous intestinal-type epithelium forming tufted pseudopapillary structures with low-grade cytological atypia and scattered mitoses.

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines.

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.

Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology.

Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade=69, 62%; high-grade=24, 21%; and invasive=19, 17%) and mucinous cystic neoplasms (low-grade=20, 90%; high-grade=2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p < .01), covered >20% of the smear area (32% vs. none, p < .01), and contained histiocytes (46% vs. 18%, p=.04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN.

Surgical treatment for pancreatic cystic lesions—implications from the multi-center and prospective German StuDoQ|Pancreas registry

PurposeThe detection of pancreatic cystic lesions (PCL) causes uncertainty for physicians and patients, and international guidelines are based on low evidence. The extent and perioperative risk of resections of PCL in Germany needs comparison with these guidelines to highlight controversies and derive recommendations.MethodsClinical data of 1137 patients who underwent surgery for PCL between 2014 and 2019 were retrieved from the German StuDoQ|Pancreas registry. Relevant features for preoperative evaluation and predictive factors for adverse outcomes were statistically identified.ResultsPatients with intraductal papillary mucinous neoplasms (IPMN) represented the largest PCL subgroup (N = 689; 60.6%) while other entities (mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN), neuroendocrine tumors, pseudocysts) were less frequently resected. Symptoms of pancreatitis were associated with IPMN (OR, 1.8; P = 0.012) and pseudocysts (OR, 4.78; P < 0.001), but likewise lowered the likelihood of MCN (OR, 0.49; P = 0.046) and SCN (OR, 0.15, P = 0.002). A total of 639 (57.2%) patients received endoscopic ultrasound before resection, as recommended by guidelines. Malignancy was histologically confirmed in 137 patients (12.0%), while jaundice (OR, 5.1; P < 0.001) and weight loss (OR, 2.0; P = 0.002) were independent predictors. Most resections were performed by open surgery (N = 847, 74.5%), while distal lesions were in majority treated using minimally invasive approaches (P < 0.001). Severe morbidity was 28.4% (N = 323) and 30d mortality was 2.6% (N = 29). Increased age (P = 0.004), higher BMI (P = 0.002), liver cirrhosis (P < 0.001), and esophageal varices (P = 0.002) were independent risk factors for 30d mortality.ConclusionWith respect to unclear findings frequently present in PCL, diagnostic means recommended in guidelines should always be considered in the preoperative phase. The therapy of PCL should be decided upon in the light of patient-specific factors, and the surgical strategy needs to be adapted accordingly.

Mucinous cystic neoplasm of the liver

Mucinous cystic neoplasm of the liver

ROBOTIC APPROACH IN 10 CASES OF CORPOROCAUDAL PANCREATECTOMY. INITIAL EXPERIENCE OF A BILIO-PANCREATIC UNIT

Abstract Introduction The aim of this paper is to analyze the validity and safety of a new robotic approach implantation program in the corporocaudal pancreatectomy (PCC) in a Bilio-Pancreatic Unit, evaluating morbi-mortality and hospital stay. Methods Given the controversy of which is the best therapeutic option in distal pancreatectomy in clinical process surgery tributaries, we designed this prospective, non-randomized, single-center study of pancreatic resection with Robotic approach). Ten patients (7 women and 3 men) were included, with a mean age of 57.8 years, (range 36–73 years). In all patients, the body mass index was higher than 30 and the diagnosis was made with a preoperative computed tomography. Results The robotic approach was successful in all cases, performing a corporal-caudal pancreatectomy associated with splenectomy. Blood loss was minimal during intervention, not requiring any blood transfusion. The mean operative time was 135.8 minutes. Conversion to open surgery was not necessary. Three patients had postoperative complications when a CT scan diagnosed an intra-abdominal collection in the left hypocondrium. It was resolved by percutaneous radiological drainage. Median hospital stay was 4 days (3–15). There was not perioperative mortality at 90 days. Anatomopathological study showed 5 mucinous cystic neoplasms, 2 adenocarcinomas of the pancreas and 3 well-differentiated neuroendocrine tumors. Mean size of the lesions were 4.8 cm (2.4–9). Conclusions Robotic distal pancreatectomy is an effective and safe technique. In addition, postoperative morbidity and hospital stay decreases.

Are pancreatic mucinous cystic neoplasms affected by gestation? A multicentric case control study

Background: Mucinous cystic neoplasms (MCN) of the pancreas are characterized by an inner layer of mucin-secreting cells and an ovarian-like stroma expressing estrogen and progesterone receptors. MCN have a potential for invasive degeneration and surgical resection is recommended by the international guidelines. Several case reports available in literature describe MCN undergoing a rapid increase in size during gestation. These case reports together with their histological characteristics created speculation about the possible interaction of MCN with hormones of gestation and systemic contraceptives. The aim of this study is to assess if pregnancy is a risk factor for malignant degeneration pancreatic MCN.

Cost-effectiveness of operative intervention for mucinous cystic neoplasm: The role of post-operative diabetes

Background: Mucinous cystic neoplasms (MCNs) of the pancreas are rare cystic tumors, primarily within the pancreatic body and tail, with low malignancy potential. The radiologic and pathologic characteristics of the cyst dictate the treatment strategy. For MCNs of 2cm without high-risk stigmata or worrisome features, current guidelines recommend resection in young, otherwise healthy, patients given the need for prolonged surveillance; however, the clinical and economic consequences of distal pancreatectomy, including development of diabetes (DM), are not considered with these recommendations. We therefore conducted a cost-effectiveness analysis to evaluate the benefits and risks of continued surveillance versus operative resection for small MCNs.

Surgical resection of small, localized mucinous cystic neoplasm is associated with improved survival

Background: Mucinous Cystic Neoplasms (MCN) of the pancreas are defined by the presence of ovarian stroma, harbor significant malignant potential and are often treated with surgical resection. The 2018 European consensus guidelines on pancreatic cystic neoplasms suggested a potential role for observation of MCNs which are less than 4cm and have no “high risk features”. This study set out to explore the role of surgery and/or chemotherapy in clinically node negative MCN ≤4cm (T1-2) and the potential for occult lymph node involvement in these small tumors.

Clinical and Molecular Attributes and Evaluation of Pancreatic Cystic Neoplasm.

Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) are all considered "Pancreatic cystic neoplasms (PCNs)" and show a varying risk of developing into pancreatic ductal adenocarcinoma (PDAC). These lesions display different molecular characteristics, mutations, and clinical manifestations. A lack of detailed understanding of PCN subtype characteristics and their molecular mechanisms limits the development of efficient diagnostic tools and therapeutic strategies for these lesions. Proper in vivo mouse models that mimic human PCNs are also needed to study the molecular mechanisms and for therapeutic testing. A comprehensive understanding of the current status of PCN biology, mechanisms, current diagnostic methods, and therapies will help in the early detection and proper management of patients with these lesions and PDAC. This review aims to describe all these aspects of PCNs, specifically IPMNs, by describing the future perspectives.

Adjuvant therapy for resected invasive mucinous cystic neoplasms may not be needed for all patients

Background: The surgical and adjuvant management of mucinous cystic neoplasms (MCNs) lacks formal guidelines and data is limited to institutional studies. Factors associated with receipt of adjuvant therapy and any associated impact on survival remain to be clarified.

Diagnostic value of EUS-guided SF6 pancreatography for pancreatic cystic lesions on cyst communication with the pancreatic duct.

ERCP remains the reliable method to determine whether pancreatic cystic lesions (PCLs) and pancreatic duct communicate when other modalities (computed tomography, magnetic resonance imaging, and EUS) fail. However, complications after ERCP are still a risk that should not be ignored. In this study, we evaluated the value of EUS-guided SF6 pancreatography (ESP) for the diagnosis of PCLs focusing on pancreatic cyst communication with the pancreatic duct. We reviewed the database of medical records to retrieve the clinicopathological data of the patients with PCLs who had undergone ESP, and analyzed the diagnostic value of ESP to determine communication between the cyst and the pancreatic duct. The inclusion criteria were as follows: (1) PCLs were pathologically diagnosed by postsurgery specimen or through-the-needle biopsy and (2) ESP was performed to determine communication between the pancreatic cyst and the pancreatic duct. Pathological diagnosis confirmed communication with the pancreatic duct in all eight patients with positive pancreatography, among whom seven were branch-duct-intraductal papillary mucinous neoplasm (BD-IPMN) and one was the main duct-IPMN. Pathological diagnosis confirmed noncommunication with the pancreatic duct in 20 of the 21 patients with negative pancreatography, among whom 11 were mucinous cystic neoplasm, 7 were serous cystic neoplasm, 1 was solid pseudopapillary neoplasm, 1 was pancreatic pseudocyst, and 1 was BD-IPMN. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ESP to determine communication between the pancreatic cyst and the pancreatic duct were 96.6% (28/29), 88.9% (8/9), 100% (20/20), 100% (8/8), and 95.2% (20/21), respectively. ESP achieved high accuracy to determine communication between the pancreatic cyst and the pancreatic duct.