PDF herunterladen
Endoscopy 2011; 43(7): 585-590
DOI: 10.1055/s-0030-1256440
Original article
 
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study

K.  de Jong1 , J.-W.  Poley2 , J.  E.  van Hooft1 , M.  Visser3 , M.  J.  Bruno2 , P.  Fockens1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  • 2Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  • 3Department of Pathology, Academic Medical Center, Amsterdam, University of Amsterdam, The Netherlands
Weitere Informationen

Publikationsverlauf

submitted 19 August 2010

accepted after revision 31 January 2011

Publikationsdatum:
24. Mai 2011 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Siehe auch:

Commentaire de travail de K. de Jong et al., pp. 585Endoscopy 2011; 43(07): 647-647
DOI: 10.1055/s-0031-1291783

Background and study aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered a valuable and safe technique for further investigation of pancreatic cystic lesions. In the framework of a prospective study on the accuracy of EUS-FNA we report our initial technical results regarding puncture access, sample adequacy, and complications

Patients and methods: Consecutive patients with indeterminate pancreatic cystic lesions underwent EUS and EUS-FNA. Pancreatic cyst fluid was collected for cytopathological analysis and measurement of amylase, carcinoembryonic antigen (CEA), and carbohydrate antigen 19.9 (CA 19.9) levels. Main outcome parameter for this analysis was the percentage of samples adequate for cytologic and laboratory analysis.

Results: Of 143 patients (median age 63 years; median cyst size 2.8 cm) who underwent EUS, FNA was performed in 128 (90 %). The various reasons for not doing FNA included large distance between transducer and cystic lesion (n = 9), cyst not seen or too small (n = 2), and evident diagnosis not requiring FNA (n = 3). FNA was not possible in four patients (technical failures). Cyst fluid sent for cytology provided adequate cellular material in 44 cases only, accounting for an intention-to-diagnose yield of 31 % (44/143). Sufficient fluid for biochemical analysis was obtained in 68 cases (49 %). Complications occurred in three patients (2.4 %).

Conclusions: Although EUS-guided FNA was technically feasible in the majority of patients with pancreatic cystic lesions (87 %), it was possible to obtain a classifying cytopathologic diagnosis and a chemical analysis in only a third and a half of cases, respectively.

References

  • 1 Laffan T A, Horton K M, Klein A P. et al . Prevalence of unsuspected pancreatic cysts on MDCT.  AJR Am J Roentgenol. 2008;  191 802-807
    CrossrefPubMedGoogle Scholar
  • 2 Jong K D, Nio C Y, Hermans J J. et al . High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations.  Clin Gastroenterol Hepatol. 2010;  8 806-811
    CrossrefPubMedGoogle Scholar
  • 3 Kobari M, Egawa S, Shibuya K. et al . Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management.  Arch Surg. 1999;  134 1131-1136
    CrossrefPubMedGoogle Scholar
  • 4 Tanaka M, Chari S, Adsay V. et al . International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.  Pancreatology. 2006;  6 17-32
    CrossrefPubMedGoogle Scholar
  • 5 Warshaw A L, Compton C C, Lewandrowski K. et al . Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients.  Ann Surg. 1990;  212 432-443
    CrossrefPubMedGoogle Scholar
  • 6 Sarr M G, Carpenter H A, Prabhakar L P. et al . Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms?.  Ann Surg. 2000;  231 205-212
    CrossrefPubMedGoogle Scholar
  • 7 Kloppel G. Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas.  Hepatogastroenterology. 1998;  45 1981-1985
    PubMedGoogle Scholar
  • 8 Wilentz R E, Bores-Saavedra J, Zahurak M. et al . Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas.  Am J Surg Pathol. 1999;  23 1320-1327
    CrossrefPubMedGoogle Scholar
  • 9 Curry C A, Eng J, Horton K M. et al . CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment?.  AJR Am J Roentgenol. 2000;  175 99-103
    PubMedGoogle Scholar
  • 10 Koito K, Namieno T, Ichimura T. et al . Mucin-producing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography.  Radiology. 1998;  208 231-237
    PubMedGoogle Scholar
  • 11 Brugge W R. The role of EUS in the diagnosis of cystic lesions of the pancreas.  Gastrointest Endosc. 2000;  52 S18-S22
    CrossrefPubMedGoogle Scholar
  • 12 Yamaguchi K, Tanaka M. Radiologic imagings of cystic neoplasms of the pancreas.  Pancreatology. 2001;  1 633-636
    CrossrefPubMedGoogle Scholar
  • 13 Ariyama J, Suyama M, Satoh K. et al . Endoscopic ultrasound and intraductal ultrasound in the diagnosis of small pancreatic tumors.  Abdom Imaging. 1998;  23 380-386
    CrossrefPubMedGoogle Scholar
  • 14 Brugge W R, Lewandrowski K, Lee-Lewandrowski E. et al . Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.  Gastroenterology. 2004;  126 1330-1336
    CrossrefPubMedGoogle Scholar
  • 15 Ahmad N A, Kochman M L, Lewis J D. et al . Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas?.  Am J Gastroenterol. 2001;  96 3295-3300
    CrossrefPubMedGoogle Scholar
  • 16 Hammel P, Levy P, Voitot H. et al . Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas.  Gastroenterology. 1995;  108 1230-1235
    CrossrefPubMedGoogle Scholar
  • 17 Gress F G, Hawes R H, Savides T J. et al . Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography.  Gastrointest Endosc. 1997;  45 243-250
    CrossrefPubMedGoogle Scholar
  • 18 van der Waaij L A, van Dullemen H M, Porte R J. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis.  Gastrointest Endosc. 2005;  62 383-389
    Google Scholar
  • 19 Centeno B A, Warshaw A L, Mayo-Smith W. et al . Cytologic diagnosis of pancreatic cystic lesions. A prospective study of 28 percutaneous aspirates.  Acta Cytol. 1997;  41 972-980
    CrossrefPubMedGoogle Scholar
  • 20 Lewandrowski K B, Southern J F, Pins M R. et al . Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma.  Ann Surg. 1993;  217 41-47
    CrossrefPubMedGoogle Scholar
  • 21 Hammel P, Voitot H, Vilgrain V. et al . Diagnostic value of CA 72 – 4 and carcinoembryonic antigen determination in the fluid of pancreatic cystic lesions.  Eur J Gastroenterol Hepatol. 1998;  10 345-348
    CrossrefPubMedGoogle Scholar
  • 22 Johanson J F, Cooper G, Eisen G M. et al . Quality assessment of endoscopic ultrasound.  Gastrointest Endosc. 2002;  55 798-801
    CrossrefPubMedGoogle Scholar
  • 23 Cotton P B. Outcomes of endoscopy procedures: struggling towards definitions.  Gastrointest Endosc. 1994;  40 514-518
    CrossrefPubMedGoogle Scholar
  • 24 Sedlack R, Affi A, Vazquez-Sequeiros E. et al . Utility of EUS in the evaluation of cystic pancreatic lesions.  Gastrointest Endosc. 2002;  56 543-547
    CrossrefPubMedGoogle Scholar
  • 25 Hernandez L V, Bhutani M S. Endoscopic ultrasound and pancreatic cysts: a sticky situation!.  Am J Gastroenterol. 2001;  96 3229-3230
    CrossrefPubMedGoogle Scholar
  • 26 Attasaranya S, Pais S, LeBlanc J. et al . Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts.  JOP. 2007;  8 553-563
    Google Scholar
  • 27 Brugge W R, Lewandrowski K, Lee-Lewandrowski E. et al . Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.  Gastroenterology. 2004;  126 1330-1336
    CrossrefPubMedGoogle Scholar
  • 28 Frossard J L, Amouyal P, Amouyal G. et al . Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions.  Am J Gastroenterol. 2003;  98 1516-1524
    CrossrefPubMedGoogle Scholar
  • 29 Alles A J, Warshaw A L, Southern J F. et al . Expression of CA 72-4 (TAG-72) in the fluid contents of pancreatic cysts. A new marker to distinguish malignant pancreatic cystic tumors from benign neoplasms and pseudocysts.  Ann Surg. 1994;  219 131-134
    CrossrefPubMedGoogle Scholar
  • 30 Lewandrowski K B, Warshaw A L, Compton C C. et al . Variability in cyst fluid carcinoembryonic antigen level, fluid viscosity, amylase content, and cytologic findings among multiple loculi of a pancreatic mucinous cystic neoplasm.  Am J Clin Pathol. 1993;  100 425-427
    PubMedGoogle Scholar
  • 31 Bassi C, Salvia R, Gumbs A A. et al . The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3.  Langenbecks Arch Surg. 2002;  387 281-285
    CrossrefPubMedGoogle Scholar
  • 32 Lee L S, Saltzman J R, Bounds B C. et al . EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors.  Clin Gastroenterol Hepatol. 2005;  3 231-236
    CrossrefPubMedGoogle Scholar
  • 33 O’Toole D, Palazzo L, Arotcarena R. et al . Assessment of complications of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 470-474
    CrossrefPubMedGoogle Scholar
  • 34 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
    CrossrefPubMedGoogle Scholar
  • 35 Varadarajulu S, Eloubeidi M A. Frequency and significance of acute intracystic hemorrhage during EUS-FNA of cystic lesions of the pancreas.  Gastrointest Endosc. 2004;  60 631-635
    CrossrefPubMedGoogle Scholar
  • 36 Al-Haddad M, Raimondo M, Woodward T. et al . Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study.  Gastrointest Endosc. 2007;  65 894-898
    CrossrefPubMedGoogle Scholar
  • 37 Bruno M, Bosco M, Carucci P. et al . Preliminary experience with a new cytology brush in EUS-guided FNA.  Gastrointest Endosc. 2009;  70 1220-1224
    CrossrefPubMedGoogle Scholar

P. FockensMD, PhD 

Academic Medical Center

P.O. Box 22700
1100 DE Amsterdam
The Netherlands

Fax: +31-206-917033

eMail: p.fockens@amc.nl

      >