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.
|Cytologic Diagnostic category||Non-Diagnostic||Cyst contents only, epithelium absent||Cyst contents and benign appearing neoplastic epithelium|
|Number||2||3 non-mucinous||7 mucinous||2 non-mucinous||6 mucinous|
|Cyst fluid CEA (ng/ml)||1 case > 800, 1 case ND||2 cases < 2, 1 case ND||5 cases > 800, 1 case < 2, 1 case ND||1 case > 800, 1 case ND||2 cases > 800, 2 cases > 400, 1 case < 10, 1 case ND|
|Histologic Diagnosis||2 MCNs||2 pseudocysts, 1 serous cystadenoma||4 MCNs, 1 IPMN, 2 non-neoplastic cysts¹||2 serous cystadenomas||6 MCNs|
|Implication||Recommend repeat FNA, especially with high cyst fluid CEA||Identification of mucin and high cyst fluid CEA is highly predictive of a neoplasm||Identification of mucin and neoplastic epithelium with or without high cyst fluid CEA is highly predictive of a neoplasm|