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Diagnostic des lésions kystiques du pancréas par l'aspiration à l'aiguille fine guidée sous échoendoscopie digestive Quel prélèvement et pourquoi? Utilité de la microbiopsie sur la paroi du kyste et de l'analyse du liquide en technique monocouche

Diagnosis of cystic pancreatic lesions by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) — Which sampling and why? Utility of cyst wall microbiopsy and fluid analysis by monolayered processing

  • Tumerus Kystiques du Pancréas
  • Published:
Acta Endoscopica

Résumé

La découverte d'une lésion kystique du pancréas pose de difficiles problèmes de prise en charge. Le traitement est fonction de la nature bénigne ou maligne du kyste. Les données fournies par l'examen clinique et l'imagerie ne permettent pas un diagnostic préopératoire, même si l'échoendoscopie digestive a un rôle important dans le diagnostic de ces lésions kystiques dont certaines sont potentiellement malignes. L'analyse biochimique du liquide intra-kystique (marqueurs tumoraux et enzymes pancréatiques) a été proposée pour permettre de préciser la nature du kyste. L'aspiration à l'aiguille fine permet un diagnostic fiable uniquement si la ponction et le traitement de l'échantillon suivent rigoureusement un mode opératoire spécifique. Les différents points critiques concernant le prélèvement, la préparation de l'échantillon cellulaire et de la microbiopsie sont étudiés. Une étude combinée cytologique et histologique est recommandéc. Dans ces conditions, il est facile de faire un diagnostic positif de lésions kystiques telles que le cystadénocarcinome mucineux, l'adénocarcinome canalaire nécrotique, le carcinome à cellules acineuses, les tumeurs endocrines et la tumeur solide pseudopapillaire. Il convient ensuite de différencier les tumeurs mucineuses de celles qui ne le sont pas. La cytologie monocouche est utile pour faire le diagnostic des tumeurs paucicellulaires comme le cystadénome séreux; elle permet de compléter l'analyse en autorisant des études immunocytochimiques.

Summary

The discovery of a pancreatic cystic lesion implies a challenge for the physician. The selection of the appropriate treatment depends on the ability to distinguish benign from malignant cysts. The clinical and radiological features of these lesions may not permit a preoperative diagnosis, even if endoscopic ultrasonography has an important role to determine which cystic lesions have malignant potential. Analysis of cyst fluid aspirates for tumor markers and enzymes has been proposed as an aid to differential diagnosis. An accurate diagnosis by fine-needle aspiration (FNA) needs a careful and specific handling and preparation of the sample. Critical issues for preparation of sample, cytological and histological procedures are reviewed. Combined cytology and microbiopsy are recommended. FNA provides easy and definitive diagnosis for mucinous cystadenocarcinoma, necrotic ductal carcinoma, acinar cell carcinoma, endocrine neoplasms and solid pseudopapillary tumor. Then the major role of FNA is to differentiate mucinous from nonmucinous pancreatic cyst. Monolayered smears are useful for paucicellular tumors such as serous cystadenoma and for ancillary techniques such as immunodetection.

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  1. Laboratoire d'Anatomie et de Cytologie Pathologiques, CHU de Bicêtre, Université Paris Sud, 78, rue du Général-Leclerc, 94275, La Kremlin-Bicêtre, (France

    Monique Fabre

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Fabre, M. Diagnostic des lésions kystiques du pancréas par l'aspiration à l'aiguille fine guidée sous échoendoscopie digestive Quel prélèvement et pourquoi? Utilité de la microbiopsie sur la paroi du kyste et de l'analyse du liquide en technique monocouche. Acta Endosc 32, 71–83 (2002). https://doi.org/10.1007/BF03018032

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