Does endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides adequate material for cytology and biochemical analysis?

摘要

Recent data suggest that endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is of limited value in the management of pancreatic cysts (1).In this prospective study endoscopic ultrasound (EUS)-guided FNA was done in 128 patients. Material was sent for cytology from 124/128 patients (96.8%). A classifying diagnosis was obtained in only 44/124 patients (35.4%). Sufficient fluid was available for biochemical analysis in 80/124 cases (64.5%) and analysis succeeded in 70/124 patients (56.4%). Given these results the authors concluded that EUS-FNA has a limited role in the diagnostic approach of pancreatic cysts.In order to address the question whether EUS guided-FNA of pancreatic cysts provides sufficient material for cytology and laboratory analysis, a retrospective analysis was done of all EUS guided-FNA examinations for pancreatic cysts performed in our centre between the period 2000-2011. Characteristics of patients and cysts are shown in Table 1. A total of 68 patients were included (43 females, 25 males) with a median age of 63 years (range : 33-86). In total, 70 cysts were punctured. Eight were located, at the uncinated process (11.4%), 30 at the head (42.9%), 24 at the corpus (34.3%) and 8 at the tail of the pancreas (11.4%). The median size of the cysts was 22.2 mm (range 4-68). In 10 out of 70 cases the cy-tological examination was not conclusive while in 60/70 (85.7%) of cases a cytological diagnosis was obtained (Table 2). Moreover, in 43/70 (61.4%) the pathologist could identify specific cytological criteria that further enhanced his diagnostic accuracy. Predictive factor of a conclusive cytological examination was a bigger cyst size (23.75 mm (range 4-68) versus 13.35 mm (range 8-31), p = 0.023, Mann-Whitney test, SPSS 17). Fluid biochemical analysis succeeded in 42/70 cases (60%).