[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 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

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