Endoscopic ultrasound has an important role in predicting a potential malignant transformation of cystic pancreatic tumor

Aims Cystic pancreatic tumors are common findings in abdominal ultrasound and abdominal MSCT or MR. Some cystic pancreatic tumors have malignant potential like intraductal papillary mucinous neoplasm (IPMN), cystic endocrine tumor, mucinous cystadenoma or pseudopapillary tumor. Endoscopic ultrasound (EUS) can play an important role in assessing the malignant potential of pancreatic cystic tumors [1].

Methods 297 adult patients with a pancreatic cystic lesion visualized on abdominal MSCT or MR in the period from January 2009 to December 2019 were included in a retrospective study. Endoscopic ultrasound (EUS) was performed in 170 patients, and EUS fine needle aspiration (EUS FNA) with 19- and 22-gauge needles in 136 patients, who are included in further diagnostic processing. The size of the cystic tumor, cystic wall thickness, the presence of a solid component and main pancreatic duct (MPD) width were evaluated. EUS FNA samples were also analyzed. The data of interest were the levels of carcinoembryonic antigen (CEA), cystic levels of amylase and the cytologic analysis.

Results Patients were predominatly female (75.1%) with a mean age of 67±4 years. The mean tumor diameter was 18.5±10.2 mm and the majority were unilocular (85.3%). Cystic tumors were mostly frequently found in the head of the pancreas (36%). In the subgroup of patients on whom EUS FNA was performed IPMN was diagnosed in 37.7%, mucinous cystic neoplasm in 6.1%, and serous cystic neoplasm in 13.9% of patients while other cystic tumors (42.3%) were classified as benign. The area under the receiver operating characteristics curve (AUC) was 0.932 which yields diagnostic accuracy of 93%, sensitivity of 100% and specificity of 93%. The predictors of malignancy were the presence of a solid component (OR 3.3, CI 95%, 1.349-8.051, p=0.09) and main pancreatic duct dilatation (OR 4.2, CI 95% 1.64-10.8, p=0.03).

Conclusions Cystic pancreatic tumors are predominatly benign tumors that occur more frequently in females. EUS FNA plays an important role in predicting a potential malignant transformation of a cystic pancreatic tumor.

Publication History

Article published online:
27 March 2025

• References

• 1 Tanaka M, Chari S, Adsay V. et al International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas