Endoscopy 2020; 52(S 01): S315-S316
DOI: 10.1055/s-0040-1705017
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Endoscopic ultrasound ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

A RETROSPECTIVE REVIEW TO COMPARE THE VALUE OF PANCREATIC CYST FLUID ANALYSIS AT EUS WITH POST-OPERATIVE HISTOLOGY

G Mellotte
1   Tallaght Hospital, Gastroenterology, Dublin, Ireland
,
V Parihar
1   Tallaght Hospital, Gastroenterology, Dublin, Ireland
,
N Breslin
1   Tallaght Hospital, Gastroenterology, Dublin, Ireland
,
K Conlon
2   Tallaght Hospital, Professorial Surgical Unit, Dublin, Ireland
,
P Ridgway
2   Tallaght Hospital, Professorial Surgical Unit, Dublin, Ireland
,
BM Ryan
1   Tallaght Hospital, Gastroenterology, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims To assess clinical value of EUS-guided pancreatic cystic lesion FNA performed in TUH from 2012-2019.

Methods A retrospective review of the EUS database to identify all PCL cases. PCL characteristics, fluid cytology and CEA results were reviewed. Post-operative histology was reviewed in patients with subsequent surgery.

Results 291 patients(166 female) with PCLs were identified. Mean size was 17mm ±11.5mm. 93(31%) PCLs underwent FNA and were significantly larger (25.6±12.5mm) than PCLs not aspirated (12.85±8.2mm), p< 000.1.

70 of 93(75.2%) FNA samples were sufficient for cytology analysis: 36(51.4%) were acellular, 12(17.1%) diagnostic of mucinous PCL, 1(1.4%) neuroendocrine tumour, 1(1.4%)

malignant, 10(14.2%) inflammatory, 10(14.2%) serous. Mucin stained positive in 16/93(17%). 46/93 samples (49.4%) were suitable for CEA analysis. 17 cases had CEA level >192ng/ml.

Overall 34 of 93(44%) had a positive cytology, positive mucin stain or raised CEA indicative of a mucinous PCL.

Post-operative histology was available for 13 cases; 1 poorly differentiated Adenocarcinoma, 7 IPMN, 3 MCN, 1 NET, 1 Serous cystic adenoma.

11 patients had an FNA prior to surgery, 4 with a diagnostic cytology. 3 cytology reports matched histology post resection. 1 histology was poorly differentiated adenocarcinoma with minor component IPMN which was reported as IPMN at cytology. The sensitivity of FNA cytology was low at 30.00% (6.67-65.25%) but highly specific with 100.00% (CI 2.5%-100.00%) of our diagnostic cytology from FNA at EUS matching definitive surgical histology. 5 had CEA >192, mucin was present in 3 patients. 5 patients had no positive markers for a mucinous PCL.

Conclusions Where FNA was performed the return of cytology was modest; mucin staining and CEA analysis were of additive value in the overall assessment. Where definitive surgical diagnosis was available we found that cytology was accurate when diagnostic but the overall yield was low and not a reliably sensitive biomarker for diagnosis in our patient cohort.