Age and cystic size are associated with clinical impact of endoscopic ultrasonography-guided fine-needle aspiration on the management of pancreatic cystic neoplasms

Abstract Objectives: The clinical impact of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in managing pancreatic cystic neoplasms (PCNs) remains controversial. The aim of this study was to identify which patients with PCNs would benefit from EUS-FNA. Methods: A retrospective study was performed on patients with PCNs who underwent EUS-FNA between January 2009 and June 2018. A discordant or a consistent diagnosis after EUS-FNA was analyzed and was correlated with the clinical demographic data and cystic features. Predictors of the change in the diagnosis after EUS-FNA were analyzed. Results: One hundred eighty-eight cases of PCNs were analyzed. EUS-FNA changed the diagnosis in 45.7% of all patients with PCNs and 54.5% patients with presumed branch ductal type intraductal papillary mucinous neoplasm (BD-IPMN) and impacted the recommendation in 35.6% of patients with PCNs and 50.5% patients with BD-IPMN. Patients with a discordant diagnosis after EUS-FNA were younger in age (54.8 ± 12.6 vs. 61.2 ± 14.2; p=.037) and had a cyst size larger than 3 cm than patients with a consistent diagnosis after EUS-FNA. The only worrisome feature (WF) that differed between patients with a discordant and a consistent diagnosis after EUS-FNA was the main pancreatic duct (MPD) between 5 and 9 mm (p=.013). In multivariate analysis, a cyst size >3 cm and age were independent predictors of diagnostic changes after EUS-FNA (OR: 5.33, 95% CI: 1.79–15.88, p = .003; OR: 0.96, 95% CI: 0.93–0.99, p  =  .031). Conclusions: EUS-FNA made a significant change in the management of nearly half of the patients with PCNs, especially in younger patients and in patients with a cyst size larger than 3 cm.

[1]  F. Real,et al.  European evidence-based guidelines on pancreatic cystic neoplasms , 2018 .

[2]  R. Kozarek,et al.  New guidelines for use of endoscopic ultrasound for evaluation and risk stratification of pancreatic cystic lesions may be too conservative , 2018, Surgical Endoscopy.

[3]  X. Molero,et al.  Impact of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration on the management of pancreatic cystic lesions , 2016, European journal of gastroenterology & hepatology.

[4]  Amy Wang,et al.  The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. , 2016, Gastrointestinal endoscopy.

[5]  M. Nikiforova,et al.  American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. , 2016, Gastrointestinal endoscopy.

[6]  M. Bruno,et al.  Follow-up of asymptomatic pancreatic cysts in clinical practice: A vignette questionnaire. , 2016, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[7]  P. Moayyedi,et al.  American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. , 2015, Gastroenterology.

[8]  Linda S. Lee,et al.  Endosonography in the diagnosis and management of pancreatic cysts. , 2015, World journal of gastrointestinal endoscopy.

[9]  Vikesh K. Singh,et al.  Should We Do EUS/FNA on Patients With Pancreatic Cysts? The Incremental Diagnostic Yield of EUS Over CT/MRI for Prediction of Cystic Neoplasms , 2013, Pancreas.

[10]  J. S. Santos,et al.  Impact of endoscopic ultrasound-guided fine-needle aspiration on incidental pancreatic cysts. A prospective study , 2013, Scandinavian journal of gastroenterology.

[11]  D. Gouma,et al.  Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions , 2012, Scandinavian journal of gastroenterology.

[12]  W. Heindel,et al.  Diagnostic and radiological management of cystic pancreatic lesions: important features for radiologists. , 2012, Clinical radiology.

[13]  Jin-Young Jang,et al.  International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. , 2012, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[14]  Z. Liao,et al.  Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. , 2011, Gastrointestinal endoscopy.

[15]  R. Doi,et al.  Clinicopathological Features and Prognosis of Mucinous Cystic Neoplasm With Ovarian-Type Stroma: A Multi-Institutional Study of the Japan Pancreas Society , 2011, Pancreas.

[16]  B. Spiegel,et al.  Asymptomatic pancreatic cystic neoplasms: maximizing survival and quality of life using Markov-based clinical nomograms. , 2010, Gastroenterology.

[17]  S. Thayer,et al.  Current trends in pancreatic cystic neoplasms. , 2009, Archives of surgery.

[18]  C. McCulloch,et al.  Characterization of cystic pancreatic masses: relative accuracy of CT and MRI. , 2007, AJR. American journal of roentgenology.

[19]  M. Gonen,et al.  A Selective Approach to the Resection of Cystic Lesions of the Pancreas: Results From 539 Consecutive Patients , 2006, Annals of surgery.

[20]  Andrew L Warshaw,et al.  Cystic Neoplasms of the Pancreas , 2006 .

[21]  Elizabeth Lee-Lewandrowski,et al.  Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. , 2004, Gastroenterology.

[22]  L. Spahr,et al.  Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions , 2003, American Journal of Gastroenterology.

[23]  W. Brugge,et al.  Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS. , 2001, Gastrointestinal endoscopy.

[24]  C. Pasquali,et al.  Serum tumor markers and cyst fluid analysis are useful for the diagnosis of pancreatic cystic tumors , 1996, Cancer.

[25]  D. Faigel,et al.  ASGE guideline: complications of EUS. , 2005, Gastrointestinal endoscopy.