EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in re
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and Other Interventional Techniques
EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross‑sectional imaging in resected cases Sahar Wesali1 · Mehmet A. Demir2 · Caroline S. Verbeke3 · Mats Andersson4,5 · Svein Olav Bratlie6 · Riadh Sadik1 Received: 7 July 2020 / Accepted: 15 November 2020 © The Author(s) 2020
Abstract Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma. Keywords Pancreatic cystic lesions · IPMN · MCN · Pancreatic adenocarcinoma · EUS-FNA · Cross-sectional imaging With the increased use of advanced cross-sectional imaging techniques in recent decades, incidentally discovered cysts in the pancreas have become more common [1]. Pancreatic Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08166-3) contains supplementary material, which is available to authorized users. * Sahar Wesali [email protected] 1
Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
2
Department of Clinical Pathology, Rigshospitalet, Copenhagen, Denmark
3
Department of Pathology, University of Oslo, and Oslo University Hospital, Oslo, Norway
cystic lesions (PCLs) constitute a heteroge
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