Abstract
Background
The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making.
Materials and Methods
Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection.
Results
A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration.
Discussion
In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am. J. Gastroenterol 2007;102:2339–49.
Belsley NA, Pitman MB, Lauwers GY, Brugge WR, Deshpande V. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2008;114:102–10.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17–32.
Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183–97.
Wiesenauer CA, Schmidt CM, Cummings OW, Yiannoutsos CT, Howard TJ, Wiebke EA, Goulet RJ Jr, McHenry L, Sherman S, Lehman GA, Cramer H, Madura JA. Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms. Arch. Surg. 2003;138:610–7.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126:1330–6.
Sahani D V, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF. Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP. Radiology 2006;238:560–9.
Chai SM, Herba K, Kumarasinghe MP, de Boer WB, Amanuel B, Grieu-Iacopetta F, Lim EM, Segarajasingam D, Yusoff I, Choo C, Frost F. Optimizing the multimodal approach to pancreatic cyst fluid diagnosis: developing a volume-based triage protocol. Cancer Cytopathol. 2013;121:86–100.
Pitman MB. Pancreatic cyst fluid triage: a critical component of the preoperative evaluation of pancreatic cysts. Cancer Cytopathol. 2013;121:57–60.
Sperti C, Pasquali C, Guolo P, Polverosi R, Liessi G, Pedrazzoli S. Serum tumor markers and cyst fluid analysis are useful for the diagnosis of pancreatic cystic tumors. Cancer 1996;78:237–43.
Sperti C, Pasquali C, Pedrazzoli S, Guolo P, Liessi G. Expression of mucin-like carcinoma-associated antigen in the cyst fluid differentiates mucinous from nonmucinous pancreatic cysts. Am. J. Gastroenterol. 1997;92:672–5.
Genevay M, Mino-Kenudson M, Yaeger K, Konstantinidis IT, Ferrone CR, Thayer S, Castillo CF, Sahani D, Bounds B, Forcione D, Brugge WR, Pitman MB. Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Ann. Surg. 2011;254:977–83.
Emerson RE, Randolph ML, Cramer HM. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of intraductal papillary mucinous neoplasm of the pancreas is highly predictive of pancreatic neoplasia. Diagn. Cytopathol. 2006;34:457–62.
Maire F, Voitot H, Aubert A, Palazzo L, O’Toole D, Couvelard A, Levy P, Vidaud M, Sauvanet A, Ruszniewski P, Hammel P. Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am. J. Gastroenterol. 2008;103:2871–7.
Michaels PJ, Brachtel EF, Bounds BC, Brugge WR, Pitman MB. Intraductal papillary mucinous neoplasm of the pancreas: cytologic features predict histologic grade. Cancer 2006;108:163–73.
Recine M, Kaw M, Evans DB, Krishnamurthy S. Fine-needle aspiration cytology of mucinous tumors of the pancreas. Cancer 2004;102:92–9.
Wu BU, Sampath K, Berberian CE, Kwok KK, Lim BS, Kao KT, Giap AQ, Kosco AE, Akmal YM, Difronzo AL, Yu W, Ngor EW. Prediction of malignancy in cystic neoplasms of the pancreas: a population-based cohort study. Am. J. Gastroenterol. 2014;109:121–9.
Zhong N, Zhang L, Takahashi N, Shalmiyev V, Canto MI, Clain JE, Deutsch JC, DeWitt J, Eloubeidi MA, Gleeson FC, Levy MJ, Mallery S, Raimondo M, Rajan E, Stevens T, Topazian M. Histologic and imaging features of mural nodules in mucinous pancreatic cysts. Clin. Gastroenterol. Hepatol. 2012;10:192–8.
Yip-Schneider MT, Wu H, Dumas RP, Hancock BA, Agaram N, Radovich M, Schmidt CM. Vascular endothelial growth factor, a novel and highly accurate pancreatic fluid biomarker for serous pancreatic cysts. J. Am. Coll. Surg. 2014;218:608–17.
Wu J, Matthaei H, Maitra A, Dal Molin M, Wood LD, Eshleman JR, Goggins M, Canto MI, Schulick RD, Edil BH, Wolfgang CL, Klein AP, Diaz LA Jr, Allen PJ, Schmidt CM, Kinzler KW, Papadopoulos N, Hruban RH, Vogelstein B. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci. Transl. Med. 2011;3:92ra66.
Hara T, Ikebe D, Odaka A, Sudo K, Nakamura K, Yamamoto H, Itami M, Hirata T, Kashimura J, Yamaguchi T. Preoperative histological subtype classification of intraductal papillary mucinous neoplasms (IPMN) by pancreatic juice cytology with MUC stain. Ann. Surg. 2013;257:1103–11.
Lee LS, Banks PA, Bellizzi AM, Sainani NI, Kadiyala V, Suleiman S, Conwell DL, Paulo JA. Inflammatory protein profiling of pancreatic cyst fluid using EUS-FNA in tandem with cytokine microarray differentiates between branch duct IPMN and inflammatory cysts. J. Immunol. Methods 2012;382:142–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shirley, L.A., Walker, J., Krishna, S. et al. Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions. J Gastrointest Surg 20, 1581–1585 (2016). https://doi.org/10.1007/s11605-016-3175-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-016-3175-2