Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts

Siriboon Attasaranya, Shireen Pais, Julia LeBlanc, Lee McHenry, Stuart Sherman, John DeWitt

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Context: Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (EUSFNA) has been increasingly utilized to differentiate malignant/pre-malignant pancreatic cysts from those that are benign or have low malignant potential. Objective: To determine the utility of EUS morphology, EUS-FNA cytology and cyst fluid analysis to distinguish mucinous cystic neoplasms from non-mucinous cystic neoplasms based on histopathology following surgical resection. Design: A retrospective, single center case series. Participants: Patients who underwent EUS and EUS-FNA of known or suspected pancreatic cysts followed by surgical resection. The final diagnosis was based on histopathology. Setting: Patients were divided in two groups: mucinous cystic neoplasms and non-mucinous cystic neoplasms. Patients with intraductal papillary mucinous tumors were excluded. Main outcome measures: Clinical profiles and EUS findings. Results: Forty-eight patients (mean age: 52 years; 29 females, 19 males) were identified: 16 mucinous cystic neoplasms and 32 non-mucinous cystic neoplasms. There were more women in the mucinous cystic neoplasm group compared to the non-mucinous cystic neoplasm group (88% vs. 47%; P=0.011) but the two groups were otherwise similar. The sensitivity, specificity and frequency of cases correctly identified of EUS-FNA cytology for the diagnosis of mucinous cystic neoplasms were 12.5% (95% CI: 2.2-37.2%), 90.6% (95% CI: 75.0-97.5%) and 64.6% (95% CI: 50.4-77.0%), respectively. Median cyst fluid CEA for the mucinous cystic neoplasm group (277 ng/mL; n=14) was significantly higher (P=0.002) than the non-mucinous cystic neoplasm group (1.5 ng/mL; n=21). Cyst fluid CEA greater than 800 ng/mL had a sensitivity of 42.9% (95% CI: 21.3-67.4%) and specificity of 95.2% (95% CI: 75.6-99.9%) for the diagnosis of mucinous cystic neoplasm. On the other hand, a cyst fluid CEA greater than a best cut-off ranging from 3.5 to 8.5 ng/mL had a sensitivity of 92.9% (95% CI: 66.5-100%), a specificity of 66.7% (14/21; 95% CL .45.2-83.0%), and an accuracy of 81.1% with a frequency of cases correctly identified of 77.1% (95% CI: 60.7-88.2%). Conclusions: EUS-FNA cytology and cyst fluid CEA greater than 800 ng/mL are insensitive but highly specific for differentiating mucinous cystic neoplasms from non-mucinous cystic neoplasms. EUS morphology alone cannot distinguish between the two groups.

Original languageEnglish
Pages (from-to)553-563
Number of pages11
JournalJournal of the Pancreas
Volume8
Issue number5
StatePublished - Sep 2007

Fingerprint

Pancreatic Cyst
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Cyst Fluid
Neoplasms
Cell Biology

Keywords

  • Biopsy, fine-needle
  • Endosonography
  • Pancreatic cyst

ASJC Scopus subject areas

  • Endocrinology
  • Gastroenterology

Cite this

Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. / Attasaranya, Siriboon; Pais, Shireen; LeBlanc, Julia; McHenry, Lee; Sherman, Stuart; DeWitt, John.

In: Journal of the Pancreas, Vol. 8, No. 5, 09.2007, p. 553-563.

Research output: Contribution to journalArticle

@article{757e30204b8e451288a34806b3af9067,
title = "Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts",
abstract = "Context: Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (EUSFNA) has been increasingly utilized to differentiate malignant/pre-malignant pancreatic cysts from those that are benign or have low malignant potential. Objective: To determine the utility of EUS morphology, EUS-FNA cytology and cyst fluid analysis to distinguish mucinous cystic neoplasms from non-mucinous cystic neoplasms based on histopathology following surgical resection. Design: A retrospective, single center case series. Participants: Patients who underwent EUS and EUS-FNA of known or suspected pancreatic cysts followed by surgical resection. The final diagnosis was based on histopathology. Setting: Patients were divided in two groups: mucinous cystic neoplasms and non-mucinous cystic neoplasms. Patients with intraductal papillary mucinous tumors were excluded. Main outcome measures: Clinical profiles and EUS findings. Results: Forty-eight patients (mean age: 52 years; 29 females, 19 males) were identified: 16 mucinous cystic neoplasms and 32 non-mucinous cystic neoplasms. There were more women in the mucinous cystic neoplasm group compared to the non-mucinous cystic neoplasm group (88{\%} vs. 47{\%}; P=0.011) but the two groups were otherwise similar. The sensitivity, specificity and frequency of cases correctly identified of EUS-FNA cytology for the diagnosis of mucinous cystic neoplasms were 12.5{\%} (95{\%} CI: 2.2-37.2{\%}), 90.6{\%} (95{\%} CI: 75.0-97.5{\%}) and 64.6{\%} (95{\%} CI: 50.4-77.0{\%}), respectively. Median cyst fluid CEA for the mucinous cystic neoplasm group (277 ng/mL; n=14) was significantly higher (P=0.002) than the non-mucinous cystic neoplasm group (1.5 ng/mL; n=21). Cyst fluid CEA greater than 800 ng/mL had a sensitivity of 42.9{\%} (95{\%} CI: 21.3-67.4{\%}) and specificity of 95.2{\%} (95{\%} CI: 75.6-99.9{\%}) for the diagnosis of mucinous cystic neoplasm. On the other hand, a cyst fluid CEA greater than a best cut-off ranging from 3.5 to 8.5 ng/mL had a sensitivity of 92.9{\%} (95{\%} CI: 66.5-100{\%}), a specificity of 66.7{\%} (14/21; 95{\%} CL .45.2-83.0{\%}), and an accuracy of 81.1{\%} with a frequency of cases correctly identified of 77.1{\%} (95{\%} CI: 60.7-88.2{\%}). Conclusions: EUS-FNA cytology and cyst fluid CEA greater than 800 ng/mL are insensitive but highly specific for differentiating mucinous cystic neoplasms from non-mucinous cystic neoplasms. EUS morphology alone cannot distinguish between the two groups.",
keywords = "Biopsy, fine-needle, Endosonography, Pancreatic cyst",
author = "Siriboon Attasaranya and Shireen Pais and Julia LeBlanc and Lee McHenry and Stuart Sherman and John DeWitt",
year = "2007",
month = "9",
language = "English",
volume = "8",
pages = "553--563",
journal = "Journal of the Pancreas",
issn = "1590-8577",
publisher = "E.S. Burioni Ricerche Bibliografiche",
number = "5",

}

TY - JOUR

T1 - Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts

AU - Attasaranya, Siriboon

AU - Pais, Shireen

AU - LeBlanc, Julia

AU - McHenry, Lee

AU - Sherman, Stuart

AU - DeWitt, John

PY - 2007/9

Y1 - 2007/9

N2 - Context: Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (EUSFNA) has been increasingly utilized to differentiate malignant/pre-malignant pancreatic cysts from those that are benign or have low malignant potential. Objective: To determine the utility of EUS morphology, EUS-FNA cytology and cyst fluid analysis to distinguish mucinous cystic neoplasms from non-mucinous cystic neoplasms based on histopathology following surgical resection. Design: A retrospective, single center case series. Participants: Patients who underwent EUS and EUS-FNA of known or suspected pancreatic cysts followed by surgical resection. The final diagnosis was based on histopathology. Setting: Patients were divided in two groups: mucinous cystic neoplasms and non-mucinous cystic neoplasms. Patients with intraductal papillary mucinous tumors were excluded. Main outcome measures: Clinical profiles and EUS findings. Results: Forty-eight patients (mean age: 52 years; 29 females, 19 males) were identified: 16 mucinous cystic neoplasms and 32 non-mucinous cystic neoplasms. There were more women in the mucinous cystic neoplasm group compared to the non-mucinous cystic neoplasm group (88% vs. 47%; P=0.011) but the two groups were otherwise similar. The sensitivity, specificity and frequency of cases correctly identified of EUS-FNA cytology for the diagnosis of mucinous cystic neoplasms were 12.5% (95% CI: 2.2-37.2%), 90.6% (95% CI: 75.0-97.5%) and 64.6% (95% CI: 50.4-77.0%), respectively. Median cyst fluid CEA for the mucinous cystic neoplasm group (277 ng/mL; n=14) was significantly higher (P=0.002) than the non-mucinous cystic neoplasm group (1.5 ng/mL; n=21). Cyst fluid CEA greater than 800 ng/mL had a sensitivity of 42.9% (95% CI: 21.3-67.4%) and specificity of 95.2% (95% CI: 75.6-99.9%) for the diagnosis of mucinous cystic neoplasm. On the other hand, a cyst fluid CEA greater than a best cut-off ranging from 3.5 to 8.5 ng/mL had a sensitivity of 92.9% (95% CI: 66.5-100%), a specificity of 66.7% (14/21; 95% CL .45.2-83.0%), and an accuracy of 81.1% with a frequency of cases correctly identified of 77.1% (95% CI: 60.7-88.2%). Conclusions: EUS-FNA cytology and cyst fluid CEA greater than 800 ng/mL are insensitive but highly specific for differentiating mucinous cystic neoplasms from non-mucinous cystic neoplasms. EUS morphology alone cannot distinguish between the two groups.

AB - Context: Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (EUSFNA) has been increasingly utilized to differentiate malignant/pre-malignant pancreatic cysts from those that are benign or have low malignant potential. Objective: To determine the utility of EUS morphology, EUS-FNA cytology and cyst fluid analysis to distinguish mucinous cystic neoplasms from non-mucinous cystic neoplasms based on histopathology following surgical resection. Design: A retrospective, single center case series. Participants: Patients who underwent EUS and EUS-FNA of known or suspected pancreatic cysts followed by surgical resection. The final diagnosis was based on histopathology. Setting: Patients were divided in two groups: mucinous cystic neoplasms and non-mucinous cystic neoplasms. Patients with intraductal papillary mucinous tumors were excluded. Main outcome measures: Clinical profiles and EUS findings. Results: Forty-eight patients (mean age: 52 years; 29 females, 19 males) were identified: 16 mucinous cystic neoplasms and 32 non-mucinous cystic neoplasms. There were more women in the mucinous cystic neoplasm group compared to the non-mucinous cystic neoplasm group (88% vs. 47%; P=0.011) but the two groups were otherwise similar. The sensitivity, specificity and frequency of cases correctly identified of EUS-FNA cytology for the diagnosis of mucinous cystic neoplasms were 12.5% (95% CI: 2.2-37.2%), 90.6% (95% CI: 75.0-97.5%) and 64.6% (95% CI: 50.4-77.0%), respectively. Median cyst fluid CEA for the mucinous cystic neoplasm group (277 ng/mL; n=14) was significantly higher (P=0.002) than the non-mucinous cystic neoplasm group (1.5 ng/mL; n=21). Cyst fluid CEA greater than 800 ng/mL had a sensitivity of 42.9% (95% CI: 21.3-67.4%) and specificity of 95.2% (95% CI: 75.6-99.9%) for the diagnosis of mucinous cystic neoplasm. On the other hand, a cyst fluid CEA greater than a best cut-off ranging from 3.5 to 8.5 ng/mL had a sensitivity of 92.9% (95% CI: 66.5-100%), a specificity of 66.7% (14/21; 95% CL .45.2-83.0%), and an accuracy of 81.1% with a frequency of cases correctly identified of 77.1% (95% CI: 60.7-88.2%). Conclusions: EUS-FNA cytology and cyst fluid CEA greater than 800 ng/mL are insensitive but highly specific for differentiating mucinous cystic neoplasms from non-mucinous cystic neoplasms. EUS morphology alone cannot distinguish between the two groups.

KW - Biopsy, fine-needle

KW - Endosonography

KW - Pancreatic cyst

UR - http://www.scopus.com/inward/record.url?scp=34648824666&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34648824666&partnerID=8YFLogxK

M3 - Article

C2 - 17873459

AN - SCOPUS:34648824666

VL - 8

SP - 553

EP - 563

JO - Journal of the Pancreas

JF - Journal of the Pancreas

SN - 1590-8577

IS - 5

ER -