Correlation of Clinical, Serological, and Endoscopic Ultrasound Findings with Diagnosis of Malignancy in Pancreatic Cystic Lesions

Introduction: Pancreatic cystic lesions (PCLs) represent a diverse group of lesions with increasing incidence. We aimed to assess the clinico-radiological correlation with diagnosis of malignancy in patients presenting with pancreatic cystic neoplasms.

Methods: A retrospective review of patients presenting to the endoscopy unit from January 2021 till December 2023 with PCLs was done. Lesions with significant solid component were excluded from the analysis. Baseline demographic details, clinical features including high-risk features, tumor markers, radiological findings including site, size and number of lesions, findings on EUS and results of sampling including fluid analysis, if performed, were noted. High-risk imaging features were defined as per the AGA criteria. Malignancy was confirmed by either EUS fluid analysis or biopsy, surgical histopathology, or temporal follow-up.

Results: Out of 104 patients with PCLs, 80 patients were included (mean age: 54.46 ± 15.837 years; 53.8% male). High-risk clinical features were seen in 40 (50%) patients. The median value of CA19-9 was 15.32 U/L. Head was the most common location in 31 (38.8%) lesions. Five patients had more than one cyst while two patients had pancreatic cystosis. The median largest dimension of cyst was 3.75 cm (IQR: 2.4–;5.0). High-risk imaging features were seen in 21 (26.3%) lesions. EUS sampling was done in 41 (51.3%) patients. There was no correlation between high-risk clinical features and high-risk EUS features (p = 0.075). High-risk clinical features and high-risk EUS features correlate with diagnosis on malignancy on univariate analysis. Levels of CA19-9 showed significant correlation with diagnosis of malignancy (p = 0.043), however, showed no association with high-risk clinical or EUS features. On multivariate analysis, only presence of high-risk EUS features corroborated with presence of malignancy (p = 0.000; OR: 8.63, 95% CI: 2.6–;28.6).

Conclusion: While high-risk clinical features and raised CA19-9 may suggest malignancy, high-risk EUS features show significant association with malignancy in PCLs.

Publication History

Article published online:
22 April 2024