ULTRASONICALLY GUIDED PERCUTANEOUS FINE NEEDLE ASPIRATION BIOPSY OF THE PANCREAS: VI: Clinical Evaluation of Percutaneous Puncture of Pancreatic Cysts

Ultrasonically guided percutaneous puncture of pancreatic cyst was performed on 5 patients with ultrasonically scanned cystic mass lesions in the left upper quadrant. The clinical purpose of the procedure is for (1) biochemical, bacteriological and cytological examinations of aspirated fluid of the cysts, (2) roentgenographic visualization of the cysts by direct injection of contrast medium, and (3) complete aspiration of the fluid of cysts for therapeutic treatment. The final diagnoses of these patients were pancreatic pseudocyst in 2 patients, pancreatic cystadenocarcinoma in 2 patients and cyst-forming metastatic lymphnode from gastric cancer in one patient, confirmed by exploratory laparotomy and/or autopsy. (1) Examinations of aspirated fluid of the cysts.-The aspirated fluid was proved fairly diagnostic. In pseudocyst, the aspirated fluid revealed very high concentration of amylase, malignant cells being not recognized cytologically. In cystadenocarcinoma, the aspirated fluid revealed low concentration of amylase and high concentrations of LDH and CEA, malignant cells being definitely recognized. In metastatic lymphnode cyst, on the otherhand, CEA was high and malignant cells were recognized, but both amylase and LDH were low in concentration. This method is of great value for differential diagnosis of cystic diseases of the pancreas. (2) Roentgenographic visualization of the cysts.-This method may be considered as very useful for clear demonstration of outline and position of the cysts. (3) Therapeutic external drainage of the fluid of cysts.-This technique was performed on 2 patients with pancreatic pseudocysts, but fluid retention recurred within a few days. The therapeutic value of the procedure is, however, still too early for the final evaluation.