Endoscopic ultrasound for the evaluation of cystic neoplasia of the pancreas

Year 2011, Volume: 19 Issue: 1, 37 - 42, 01.04.2011

Mehmet Bektaş

https://doi.org/10.17940/endoskopi.74883

Abstract

Although the exact prevalence of cystic pancreatic lesions is unknown, it is estimated to be around 1% of the general population based on large-scale observational imaging studies. Cystic pancreatic lesions are increasingly diagnosed due to the widespread use of cross-sectional imaging modalities like computed tomography and magnetic resonance imaging. Cystic lesions of the pancreas consist of pseudocysts, congenital cysts (sometimes called simple cysts) and cystic neoplasms, including serous cystadenomas, mucinous cystadenomas and cystadenocarcinomas, and intraductal papillary mucinous neoplasms. Endoscopic ultrasound provides real-time high-resolution images of cystic pancreatic lesions with morphological details. The combination of fine-needle aspiration cytology with the other recently available diagnostic markers has further increased its diagnostic accuracy.

Keywords

Endoscopic ultrasonography, pancreatic cysts

Pankreasın kistik neoplazilerinde endoskopik ultrasonografi

Abstract

Pankreas kistlerinin gerçek prevalansı bilinmemekle birlikte büyük hacimli genel popülasyonun incelenmesi çalışmalarında yaklaşık %1 olarak rapor edilmiştir. Bilgisayarlı tomografi ve manyetik rezonans gibi görüntüleme yöntemlerinin son zamanlarda yaygın kullanımıyla pankreas kistlerinin tanısında artış vardır. Pankreasın kistik lezyonları; psödokist, konjenital kistler ve seröz kist adenom, müsinöz kist adenom, müsinöz kist adenokanser ve intraduktal papiller müsinöz neoplazi gibi neoplastik kistlerinden oluşur. Endoskopik ultrasonografi pankreas kistlerinin morfolojik detayı hakkında eş zamanlı yüksek çözünürlüklü bilgi sağlar. Endoskopik ultrasonografiye ince iğne aspirasyonu sitolojisinin eklenmesiyle kistlerin tanısal doğruluğu artar.

Keywords

Endoskopik ultrasonografi, pankreas kistleri

References

• Spinelli KS, Fromwiller TE, Daniel RA, et al Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004; 239: 651-7.
• Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pan- creas. N Engl J Med 2004; 351: 1218-26.
• Fernandez-del Castillo C, Warshaw AL. Cystic neoplasms of the pancre- as. Pancreatology 2001; 1: 641-7.
• Mulkeen AL, Yoo PS, Cha C. Less common neoplasms of the pancreas. World J Gastroenterol 2006; 12: 3180-5.
• Sakorafas GH, Sarr MG. Cystic neoplasms of the pancreas; what a clini- cian should know. Cancer Treat Rev 2005; 31: 507-35.
• Hutchins GF, Draganov PV. Cystic neoplasms of the pancreas: a diag- nostic challenge. World J Gastroenterol 2009; 15: 48-54.
• Fernández-del Castillo C, Targarona J, Thayer SP, et al. Incidental pan- creatic cysts: clinicopathological characteristics and comparison with symptomatic patients. Arch Surg 2003; 138: 427-34.
• Gorin AD, Sackier JM. Incidental detection of cystic neoplasms of the pancreas. Md Med J 1997; 46: 79-82.
• Garcea G, Ong SL, Rajesh A, et al. Cystic lesions of the pancreas. A di- agnostic and management dilemma. Pancreatology 2008; 8: 236-51.
• Parra-Herran CE, Garcia MT, Herrera L, Bejarano PA. Cystic lesions of the pancreas: clinical and pathologic review of cases in a five year peri- od. JOP 2010; 11: 358-64.
• Thomas T, Bebb J, Mannath J, et al. EUS-guided pancreatic cyst brus- hing: a comparative study in a tertiary referral centre. JOP 2010; 11: 163-9.
• Al-Haddad M, Gill KR, Raimondo M, et al. Safety and efficacy of cyto- logy brushings versus standard fine-needle aspiration in evaluating cys- tic pancreatic lesions: a controlled study. Endoscopy 2010; 42: 127-32.
• Johnson CD, Stephens DH, Charboneau JW, et al. Cystic pancreatic tu- mors: CT and sonographic assessment. AJR Am J Roentgenol 1988; 151: 1133-8.
• Koito K, Namieno T, Nagakawa T, et al. Solitary cystic tumor of the pan- creas: EUS-pathologic correlation. Gastrointest Endosc 1997; 45: 268- 76.
• Curry CA, Eng J, Horton KM, et al. CT of primary cystic pancreatic ne- oplasms: Can CT be used for patient triage and treatment? AJR Am J Ro- entgenol 2000; 175: 99-103.
• Gress F, Gottlieb K, Cummings O, et al. Endoscopic ultrasound charac- teristics of mucinous cystic neoplasms of the pancreas. Am J Gastroente- rol 2000; 95: 961-5.
• Warshaw AL, Rutledge PL. Cystic tumors mistaken for pancreatic pseu- docysts. Ann Surg 1987; 205: 393-8.
• Kloppel G, Luttges J. WHO-classification 2000: exocrine pancreatic tu- mors. Verh Dtsch Ges Pathol 2001; 85: 219-28.
• Mathieu D, Guigui B, Valette PJ, et al. Pancreatic cystic neoplasms. Ra- diol Clin North Am 1989; 27: 163-76.
• Minami M, Itai Y, Ohtomo K, et al. Cystic neoplasms of the pancreas: comparison of MR imaging with CT. Radiology 1989; 171: 53-6.
• Koito K, Namieno T, Ichimura T, et al. Mucin-producing pancreatic tu- mors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998; 208: 231-7.
• Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: A report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126: 1330-6.
• Al-Haddad M, El Hajj II, Eloubeidi MA. Endoscopic ultrasound for the evaluation of cystic lesions of the pancreas. JOP 2010; 11: 299-309.
• Khalid A, Brugge W. ACG practice guidelines for the diagnosis and ma- nagement of neoplastic pancreatic cysts. Am J Gastroenterol 2007; 102: 2339-49.
• Frossard JL, Amouyal P, Amouyal G, et al. Performance of endosonog- raphy-guided fine needle aspiration and biopsy in the diagnosis of pan- creatic cystic lesions. Am J Gastroenterol 2003; 98: 1516-24.
• Attasaranya S, Pais S, LeBlanc J, et al. Endoscopic ultrasound-guided fi- ne needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 2007; 8: 553-63.
• Bektas M, Lee JH, Guha S, et al. Prevalence of extrapancreatic cysts in patients with cystic neoplasms of the pancreas. American Colloge of Gas- troenterology Meeting- San Diago 2009 (poster).
• Bektas M, Ross WA, Lee JH, et al. EUS-FNA for diagnosis of cystic pan- creatic neuroendocrine tumors: an important cause for pancreatic cysts. American Colloge of Gastroenterology Meeting- San Diago 2009 (pos- ter).
• Sugiyama M, Atomi Y. Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 1999; 94: 470-3.
• Berthélemy P, Bouisson M, Escourrou J, et al. Identification of K-ras mu- tations in pancreatic juice in the early diagnosis of pancreatic cancer. Ann Intern Med 1995; 123: 188-91.
• Tada M, Teratani T, Komatsu Y, et al. Quantitative analysis of ras gene mutation in pancreatic juice for diagnosis of pancreatic adenocarcinoma. Dig Dis Sci 1998; 43: 15-20.
• Sawhney M, Devarajan S, O'Farrell R, et al. Comparison of CEA and DNA analysis in 100 consecutive patients with pancreatic cysts. Gastro- intest Endosc 2008; 67:AB209
• Jenssen C, Dietrich CF. Endoscopic ultrasound-guided fine-needle aspi- ration biopsy and trucut biopsy in gastroenterology - An overview. Best Pract Res Clin Gastroenterol 2009; 23: 743-59.
• Gan SI, Thompson CC, Lauwers GY, et al. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc 2005; 61: 746-52.
• Dewitt et al . A prospective, randomized, double blind study of ethanol versus saline lavage of CPT. Gastrointest Endosc 2007; 65: AB106.
• Oh HC, Seo DW, Lee TY, et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastroin- test Endosc 2008; 67: 636-42.