[427] Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) of Pancreatic Cystic Lesions without Overt Cytologic Atypia: Proposed Diagnostic Categories with Utilization of Fluid Carcinoembryonic (CEA) Level

EA Khan, N Cuka, R Madan, M Olyaee, PA Thomas, F Fan. KU Medical Center, Kansas City, KS

Background: EUS-FNA is used to identify neoplastic pancreatic cysts that require resection. Particularly challenging are those lacking cytologic atypical/malignant epithelium. We reviewed our experience in EUS-FNA of pancreatic cystic lesions in an effort to identify ways to improve the diagnostic utility of this tool.
Design: We identified 247 pancreatic cystic lesions evaluated by EUS-FNA from the KU Medical Center cytology records for the period of 2002 to 2009. Twenty two (9 %) of these were resected. The initial cytologic diagnoses were inconsistent; however all cases lacked significant epithelial atypia. We retrospectively divided the cases into 3 categories: non-diagnostic, cyst contents only and cyst contents plus benign appearing neoplastic epithelium. The cytology diagnoses and the cyst fluid CEA levels were compared to the diagnoses on surgical excision.
Results: The patient population included 8 males and 14 females (age range of 21-80 years). The results are tabulated below.

EUS-FNA of pancreatic cystic lesions - Cytologic/histologic correlation
Cytologic Diagnostic categoryNon-DiagnosticCyst contents only, epithelium absentCyst contents and benign appearing neoplastic epithelium
Number23 non-mucinous7 mucinous2 non-mucinous6 mucinous
Cyst fluid CEA (ng/ml)1 case > 800, 1 case ND2 cases < 2, 1 case ND5 cases > 800, 1 case < 2, 1 case ND1 case > 800, 1 case ND2 cases > 800, 2 cases > 400, 1 case < 10, 1 case ND
Histologic Diagnosis2 MCNs2 pseudocysts, 1 serous cystadenoma4 MCNs, 1 IPMN, 2 non-neoplastic cysts¹2 serous cystadenomas6 MCNs
ImplicationRecommend repeat FNA, especially with high cyst fluid CEAIdentification of mucin and high cyst fluid CEA is highly predictive of a neoplasmIdentification of mucin and neoplastic epithelium with or without high cyst fluid CEA is highly predictive of a neoplasm
D-not done, MCN-mucinous cystic neoplasm, IPMN-intraductal papillary mucinous neoplasm, GI-gastrointestinal. ¹ Elevated CEA levels were only noted with the neoplastic cysts.

Conclusions: The proposed four diagnostic categories for pancreatic cystic lesions are easy to follow and have meaningful clinical implications when incorporated with the fluid CEA levels.
Category: Cytopathology

Wednesday, March 24, 2010 1:00 PM

Poster Session VI # 42, Wednesday Afternoon


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