Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts
Background Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis. Objective To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield. Design Prospective series. Setting Tertiary referral center. Patients Consecutive patients...
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| Veröffentlicht in: | Gastrointestinal endoscopy 2012-04, Vol.75 (4), p.775-782 |
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| creator | Hong, Shih-Kuang S., MD, MSCI Loren, David E., MD Rogart, Jason N., MD Siddiqui, Ali A., MD Sendecki, Jocelyn A., MSPH Bibbo, Marluce, MD Coben, Robert M., MD Meckes, Daniel P., AS Kowalski, Thomas E., MD |
| description | Background Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis. Objective To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield. Design Prospective series. Setting Tertiary referral center. Patients Consecutive patients with pancreatic cysts referred for EUS-FNA between March 2010 and March 2011. Intervention FNA was performed with aspiration of cyst fluid for carcinoembryonic antigen (CEA) and cytology, followed by cyst wall puncture (CWP). CWP is defined as puncturing the far wall of the cyst and moving the needle back and forth through the wall to sample the wall epithelium. Main Outcome Measurements The diagnostic yield for mucinous cystic pancreatic neoplasms by CEA and cytology obtained from cyst fluid compared with cytology obtained from CWP. CEA ≥192 ng/mL was considered mucinous. Results A total of 69 pancreatic cysts from 66 patients were included. Adequate amounts of fluid were aspirated for CEA, amylase, and cytology in 60 cysts (81%). Cellular material adequate for cytologic assessment from CWP was obtained in 56 cysts (81%). Ten (30%) of 33 cysts with CEA |
| doi_str_mv | 10.1016/j.gie.2011.12.015 |
| format | Article |
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Objective To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield. Design Prospective series. Setting Tertiary referral center. Patients Consecutive patients with pancreatic cysts referred for EUS-FNA between March 2010 and March 2011. Intervention FNA was performed with aspiration of cyst fluid for carcinoembryonic antigen (CEA) and cytology, followed by cyst wall puncture (CWP). CWP is defined as puncturing the far wall of the cyst and moving the needle back and forth through the wall to sample the wall epithelium. Main Outcome Measurements The diagnostic yield for mucinous cystic pancreatic neoplasms by CEA and cytology obtained from cyst fluid compared with cytology obtained from CWP. CEA ≥192 ng/mL was considered mucinous. Results A total of 69 pancreatic cysts from 66 patients were included. Adequate amounts of fluid were aspirated for CEA, amylase, and cytology in 60 cysts (81%). Cellular material adequate for cytologic assessment from CWP was obtained in 56 cysts (81%). Ten (30%) of 33 cysts with CEA <192 ng/mL and negative results of cyst fluid cytology had a mucinous diagnosis from CWP; 6 of 9 (67%) cysts with an insufficient amount of fluid for CEA analysis and cyst fluid cytology had a mucinous diagnosis from CWP. Furthermore, 4 malignant cysts were independently diagnosed by CWP cytology. The incremental diagnostic yield of CWP for mucinous or malignant cysts was therefore 29% (20 of 69 cysts, P = .0001). An episode of pancreatitis (1.45%) occurred. Limitation Lack of surgical criterion standard. Conclusions CWP during EUS-FNA is a safe and effective technique for improving the diagnostic yield for premalignant and malignant pancreatic cysts.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2011.12.015</identifier><identifier>PMID: 22317883</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>Maryland heights, MO: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Amylases - metabolism ; Biological and medical sciences ; Biopsy, Fine-Needle ; Carcinoembryonic Antigen - metabolism ; Digestive system. Abdomen ; Endoscopy ; Endosonography ; Female ; Gastroenterology and Hepatology ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Neoplasms, Cystic, Mucinous, and Serous - metabolism ; Neoplasms, Cystic, Mucinous, and Serous - pathology ; Pancreatic Cyst - metabolism ; Pancreatic Cyst - pathology ; Pancreatic Neoplasms - metabolism ; Pancreatic Neoplasms - pathology ; Prospective Studies ; Tumors ; Ultrasonography, Interventional</subject><ispartof>Gastrointestinal endoscopy, 2012-04, Vol.75 (4), p.775-782</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2012 American Society for Gastrointestinal Endoscopy</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-9cb7d72d57fb4577f7c126ee4885132a52cc58b48f0a0f59af133badabe98b403</citedby><cites>FETCH-LOGICAL-c503t-9cb7d72d57fb4577f7c126ee4885132a52cc58b48f0a0f59af133badabe98b403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.gie.2011.12.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25727319$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22317883$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hong, Shih-Kuang S., MD, MSCI</creatorcontrib><creatorcontrib>Loren, David E., MD</creatorcontrib><creatorcontrib>Rogart, Jason N., MD</creatorcontrib><creatorcontrib>Siddiqui, Ali A., MD</creatorcontrib><creatorcontrib>Sendecki, Jocelyn A., MSPH</creatorcontrib><creatorcontrib>Bibbo, Marluce, MD</creatorcontrib><creatorcontrib>Coben, Robert M., MD</creatorcontrib><creatorcontrib>Meckes, Daniel P., AS</creatorcontrib><creatorcontrib>Kowalski, Thomas E., MD</creatorcontrib><title>Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis. Objective To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield. Design Prospective series. Setting Tertiary referral center. Patients Consecutive patients with pancreatic cysts referred for EUS-FNA between March 2010 and March 2011. Intervention FNA was performed with aspiration of cyst fluid for carcinoembryonic antigen (CEA) and cytology, followed by cyst wall puncture (CWP). CWP is defined as puncturing the far wall of the cyst and moving the needle back and forth through the wall to sample the wall epithelium. Main Outcome Measurements The diagnostic yield for mucinous cystic pancreatic neoplasms by CEA and cytology obtained from cyst fluid compared with cytology obtained from CWP. CEA ≥192 ng/mL was considered mucinous. Results A total of 69 pancreatic cysts from 66 patients were included. Adequate amounts of fluid were aspirated for CEA, amylase, and cytology in 60 cysts (81%). Cellular material adequate for cytologic assessment from CWP was obtained in 56 cysts (81%). Ten (30%) of 33 cysts with CEA <192 ng/mL and negative results of cyst fluid cytology had a mucinous diagnosis from CWP; 6 of 9 (67%) cysts with an insufficient amount of fluid for CEA analysis and cyst fluid cytology had a mucinous diagnosis from CWP. Furthermore, 4 malignant cysts were independently diagnosed by CWP cytology. The incremental diagnostic yield of CWP for mucinous or malignant cysts was therefore 29% (20 of 69 cysts, P = .0001). An episode of pancreatitis (1.45%) occurred. Limitation Lack of surgical criterion standard. Conclusions CWP during EUS-FNA is a safe and effective technique for improving the diagnostic yield for premalignant and malignant pancreatic cysts.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amylases - metabolism</subject><subject>Biological and medical sciences</subject><subject>Biopsy, Fine-Needle</subject><subject>Carcinoembryonic Antigen - metabolism</subject><subject>Digestive system. Abdomen</subject><subject>Endoscopy</subject><subject>Endosonography</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasms, Cystic, Mucinous, and Serous - metabolism</subject><subject>Neoplasms, Cystic, Mucinous, and Serous - pathology</subject><subject>Pancreatic Cyst - metabolism</subject><subject>Pancreatic Cyst - pathology</subject><subject>Pancreatic Neoplasms - metabolism</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Prospective Studies</subject><subject>Tumors</subject><subject>Ultrasonography, Interventional</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksFu1DAURS0EotPCB7BB3iBWCX5OPE6EhFRVLSBVsGi7thz7ZfCQcYLtgOYL-O06nYFKLFhZts69zzp6hLwCVgKD9bttuXFYcgZQAi8ZiCdkBayVxVrK9ilZsQwVApg8IacxbhljDa_gOTnh-ZBNU63I71sdNpjQUrOPif7Sw0Cn2Zs0B6TaW6rj5IJObvTUzsH5Db28uymuvpxT501AHTHS9A2pdXrjx5icoXuHg6VjT6eAOz24jdc-PZQ93ib9kF7wZXB8QZ71eoj48niekbury9uLT8X114-fL86vCyNYlYrWdNJKboXsu1pI2UsDfI1YN42AimvBjRFNVzc906wXre6hqjptdYdtfmbVGXl76J3C-GPGmNTORYPDoD2Oc1RtbmrrbCqTcCBNGGMM2KspuJ0OewVMLfrVVmX9atGvgKusP2deH9vnbof2b-KP7wy8OQI6Gj30IWtw8ZETkssK2sy9P3CYXfx0GFQ0Dr1B6wKapOzo_vuND_-kzeC8ywO_4x7jdpyDz5IVqJgD6mbZk2VNABgXtairezqWuWk</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Hong, Shih-Kuang S., MD, MSCI</creator><creator>Loren, David E., MD</creator><creator>Rogart, Jason N., MD</creator><creator>Siddiqui, Ali A., MD</creator><creator>Sendecki, Jocelyn A., MSPH</creator><creator>Bibbo, Marluce, MD</creator><creator>Coben, Robert M., MD</creator><creator>Meckes, Daniel P., AS</creator><creator>Kowalski, Thomas E., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120401</creationdate><title>Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts</title><author>Hong, Shih-Kuang S., MD, MSCI ; Loren, David E., MD ; Rogart, Jason N., MD ; Siddiqui, Ali A., MD ; Sendecki, Jocelyn A., MSPH ; Bibbo, Marluce, MD ; Coben, Robert M., MD ; Meckes, Daniel P., AS ; Kowalski, Thomas E., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-9cb7d72d57fb4577f7c126ee4885132a52cc58b48f0a0f59af133badabe98b403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amylases - metabolism</topic><topic>Biological and medical sciences</topic><topic>Biopsy, Fine-Needle</topic><topic>Carcinoembryonic Antigen - metabolism</topic><topic>Digestive system. Abdomen</topic><topic>Endoscopy</topic><topic>Endosonography</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasms, Cystic, Mucinous, and Serous - metabolism</topic><topic>Neoplasms, Cystic, Mucinous, and Serous - pathology</topic><topic>Pancreatic Cyst - metabolism</topic><topic>Pancreatic Cyst - pathology</topic><topic>Pancreatic Neoplasms - metabolism</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Prospective Studies</topic><topic>Tumors</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hong, Shih-Kuang S., MD, MSCI</creatorcontrib><creatorcontrib>Loren, David E., MD</creatorcontrib><creatorcontrib>Rogart, Jason N., MD</creatorcontrib><creatorcontrib>Siddiqui, Ali A., MD</creatorcontrib><creatorcontrib>Sendecki, Jocelyn A., MSPH</creatorcontrib><creatorcontrib>Bibbo, Marluce, MD</creatorcontrib><creatorcontrib>Coben, Robert M., MD</creatorcontrib><creatorcontrib>Meckes, Daniel P., AS</creatorcontrib><creatorcontrib>Kowalski, Thomas E., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hong, Shih-Kuang S., MD, MSCI</au><au>Loren, David E., MD</au><au>Rogart, Jason N., MD</au><au>Siddiqui, Ali A., MD</au><au>Sendecki, Jocelyn A., MSPH</au><au>Bibbo, Marluce, MD</au><au>Coben, Robert M., MD</au><au>Meckes, Daniel P., AS</au><au>Kowalski, Thomas E., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>75</volume><issue>4</issue><spage>775</spage><epage>782</epage><pages>775-782</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>Background Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis. Objective To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield. Design Prospective series. Setting Tertiary referral center. Patients Consecutive patients with pancreatic cysts referred for EUS-FNA between March 2010 and March 2011. Intervention FNA was performed with aspiration of cyst fluid for carcinoembryonic antigen (CEA) and cytology, followed by cyst wall puncture (CWP). CWP is defined as puncturing the far wall of the cyst and moving the needle back and forth through the wall to sample the wall epithelium. Main Outcome Measurements The diagnostic yield for mucinous cystic pancreatic neoplasms by CEA and cytology obtained from cyst fluid compared with cytology obtained from CWP. CEA ≥192 ng/mL was considered mucinous. Results A total of 69 pancreatic cysts from 66 patients were included. Adequate amounts of fluid were aspirated for CEA, amylase, and cytology in 60 cysts (81%). Cellular material adequate for cytologic assessment from CWP was obtained in 56 cysts (81%). Ten (30%) of 33 cysts with CEA <192 ng/mL and negative results of cyst fluid cytology had a mucinous diagnosis from CWP; 6 of 9 (67%) cysts with an insufficient amount of fluid for CEA analysis and cyst fluid cytology had a mucinous diagnosis from CWP. Furthermore, 4 malignant cysts were independently diagnosed by CWP cytology. The incremental diagnostic yield of CWP for mucinous or malignant cysts was therefore 29% (20 of 69 cysts, P = .0001). An episode of pancreatitis (1.45%) occurred. Limitation Lack of surgical criterion standard. Conclusions CWP during EUS-FNA is a safe and effective technique for improving the diagnostic yield for premalignant and malignant pancreatic cysts.</abstract><cop>Maryland heights, MO</cop><pub>Mosby, Inc</pub><pmid>22317883</pmid><doi>10.1016/j.gie.2011.12.015</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Amylases - metabolism Biological and medical sciences Biopsy, Fine-Needle Carcinoembryonic Antigen - metabolism Digestive system. Abdomen Endoscopy Endosonography Female Gastroenterology and Hepatology Gastroenterology. Liver. Pancreas. Abdomen Humans Investigative techniques, diagnostic techniques (general aspects) Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Neoplasms, Cystic, Mucinous, and Serous - metabolism Neoplasms, Cystic, Mucinous, and Serous - pathology Pancreatic Cyst - metabolism Pancreatic Cyst - pathology Pancreatic Neoplasms - metabolism Pancreatic Neoplasms - pathology Prospective Studies Tumors Ultrasonography, Interventional |
| title | Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts |
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