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DOI: 10.1055/s-0038-1637358
THE ADDITIVE VALUE OF ENDOSCOPIC ULTRASOUND (EUS) GUIDED FINE NEEDLE ASPIRATION (FNA) IN DIFFERENTIAL DIAGNOSIS OF PANCREATIC CYSTIC LESIONS IN A TERTIARY-CARE CENTRE
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Literature data show a low sensitivity (30 – 50%) for endoscopic ultrasound (EUS) fine needle aspiration (FNA) in differential diagnosis of pancreatic cystic lesions (PCL).
The aim of the study is to assess the value of EUS-FNA in defining the final diagnosis of PCL in a tertiary care center and its impact on patient outcome.
Methods:
EUS-FNA of PCL performed during the last 3 years was retrospectively analyzed.
All the biopsies were performed with a 22-gauge needle through a linear echoendoscope (EG3870UTK, Pentax Medical).
The cytological smears were reviewed by an highly experienced cytopathology pancreatic team.
Data recorded were: age, sex, EUS morphological variables, diagnostic suspicion (IPMN, serous cystic adenoma-SCA, cystic neuroendocrine tumor-CNT, pseudocysts, unclassified cysts) and cytological results.
Mucus finding was considered suggestive for IPMN and the absence of malignant neoplastic cells was considered to be consistent with a SCA or pseudocyst diagnosis.
Results:
231 cytological samples of 201 (102 males/99 females, mean age 66.3 ± 11.4 years) patients were analyzed (21 patients underwent to two or more EUS-FNA).
Sampled cysts were located at: pancreatic head 31.3%, uncinated process 10.9%, neck 20.9%, body 23.4% and tail 13.4%. 56.2% of patients showed multiple cysts. Mean size of the major sampled cyst was 30.3 ± 16.1 mm.
The presumptive EUS diagnoses were: 82.7% IPMNs, 6.5% SCA, 5.2% pseudocysts, 4.8% unclassified cystic lesions and 1.7% CNT.
Final cytological results were achieved in 66.7%.
When considering diagnostic subgroups, final cytological results were achieved in 65.4% for IPMNs, 93.3% for SCA, 91.7% for pseudocysts and 100% for CNT.
Conclusions:
In a tertiary care center with an highly experienced pathology team, EUS-FNA cytology impact on PCL differential diagnosis can be obtained in nearly 70% of cases. In this setting we suggest to perform EUS-FNA in patients with PCL.