Cyst Fluid Analysis in the Differential Diagnosis of Pancreatic Cysts A Comparison of Pseudocysts, Serous Cystadenomas, Mucinous Cystic Neoplasms, and Mucinous Cystadenocarcinoma

Objective: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification. Materials and Methods: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts. Results: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively. Conclusions: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.

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Cyst fluid analysis for the differential diagnosis of pancreatic cysts

Diagnostic Cytopathology ◽

10.1002/dc.20085 ◽

2004 ◽

Vol 31 (2) ◽

pp. 100-105 ◽

Cited By ~ 50

Author(s):

Ji Kon Ryu ◽

Sang Myung Woo ◽

Jin-Hyeok Hwang ◽

Ji Bong Jeong ◽

Yong Bum Yoon ◽

...

Keyword(s):

Differential Diagnosis ◽

Cyst Fluid ◽

Pancreatic Cysts ◽

Fluid Analysis

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The Yield of String Sign in Differentiating Mucinous from Non-Mucinous Pancreatic Cysts: A Retrospective Cross-Sectional Study

Medicina ◽

10.3390/medicina57070716 ◽

2021 ◽

Vol 57 (7) ◽

pp. 716

Author(s):

Wisam Sbeit ◽

Anas Kadah ◽

Amir Shahin ◽

Tawfik Khoury

Keyword(s):

Predictive Value ◽

Cross Sectional Study ◽

Pancreatic Cysts ◽

Cystic Neoplasms ◽

Cross Sectional ◽

Mucinous Cystic Neoplasms ◽

String Sign ◽

Fluid Analysis ◽

Group A ◽

Group B

Background and Objectives: The diagnosis of pancreatic cysts is mostly based on a combination of morphological appearance and fluid analysis of amylase and carcinoembryonic antigen (CEA). We aimed to assess the capability of the string sign in differentiating mucinous from non-mucinous pancreatic cysts. Materials and Methods: All patients who were referred for endoscopic ultrasound (EUS) for pancreatic cysts assessment from 2015 to 2020 were retrospectively analyzed. Results: Our cohort consisted of 112 patients. Of them, 92 patients (82.1%) had mucinous cystic neoplasms (group A) and 20 patients (17.9%) had non-mucinous cystic neoplasms (group B). The average age in groups A and B was 71.3 and 60.4 years, respectively. String sign was positive in 47 patients (51.1%) and negative in 21 patients (22.8%) in group A, while in group B, string sign was negative in 19 patients (95%). String sign showed significant correlation with the diagnosis of mucinous cystic neoplasms (OR 64.2, 95% CI 8.1–508.6, p = 0.0001). Cytology confirmed mucinous cystic neoplasms that included 32 patients; the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of string sign for mucinous cystic neoplasms were high, reaching 93.8%, 85.7%, 96.8%, and 75%, respectively, with an excellent accuracy rate of 92.3%. Conclusions: The string sign is highly accurate for predicting pancreatic mucinous cystic neoplasms, and should be used as an important aid for improving diagnostic accuracy.

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Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0308-ra ◽

2019 ◽

Vol 144 (1) ◽

pp. 47-61 ◽

Cited By ~ 5

Author(s):

Amrou Abdelkader ◽

Bryan Hunt ◽

Christopher P. Hartley ◽

Nicole C. Panarelli ◽

Tamara Giorgadze

Keyword(s):

Cyst Fluid ◽

Integrative Approach ◽

Cystic Degeneration ◽

Pancreatic Cysts ◽

Molecular Characteristics ◽

Molecular Testing ◽

Team Approach ◽

Cystic Lesions ◽

Cystic Neoplasms ◽

Fluid Analysis

Context.— Pancreatic cystic lesions (PCLs) are very common, and their detection is increasing with the advances in imaging techniques. Because of the major implications for management, distinguishing between neoplastic and nonneoplastic PCLs is critical. Neoplastic cysts with potential to progress into cancer include mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) and nonmucinous cysts (solid pseudopapillary tumors, serous cystic neoplasms, and neuroendocrine tumors with cystic degeneration). Nonneoplastic cysts with no risk of malignant transformation include pseudocysts, retention cysts, lymphoepithelial cysts, cystic pancreatic lymphangioma, and duplication cyst/ciliated foregut cysts. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology with cyst fluid analysis in the diagnosis of PCLs has evolved during the last decade; however, a definitive diagnosis on cytologic specimens is hampered by the sparse cellularity and can be challenging. EUS-FNA can play an important role to differentiate low-risk from high-risk pancreatic cysts and to distinguish between patients with cysts who need clinical follow-up versus those who require surgery. Objective.— To provide an integrative approach to diagnose pancreatic cystic lesions using EUS-FNA cytology and cyst fluid analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics. Data Sources.— The review and analysis of the latest literature describing pancreatic cystic lesions. Conclusions.— Accurate diagnosis of PCLs requires a multidisciplinary and multimodal team approach, including the integration of clinical findings, imaging, cytology, cyst fluid analysis, and molecular testing.

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Cyst fluid analysis in the differential diagnosis of pancreatic cysts: a new approach to the preoperative assessment of pancreatic cystic lesions.

American Journal of Roentgenology ◽

10.2214/ajr.164.4.7537015 ◽

1995 ◽

Vol 164 (4) ◽

pp. 815-819 ◽

Cited By ~ 67

Author(s):

K Lewandrowski ◽

J Lee ◽

J Southern ◽

B Centeno ◽

A Warshaw

Keyword(s):

Differential Diagnosis ◽

Preoperative Assessment ◽

Cyst Fluid ◽

Pancreatic Cysts ◽

Cystic Lesions ◽

New Approach ◽

Fluid Analysis

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Utility of EUS-FNA and Cyst Fluid Analysis in the Diagnosis of Pancreatic Cysts: Correlation with Histopathology in 51 Patients

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2006.03.715 ◽

2006 ◽

Vol 63 (5) ◽

pp. AB278 ◽

Cited By ~ 1

Author(s):

Siriboon Attasaranya ◽

Shireen A. Pais ◽

Julia K. Leblanc ◽

Stuart Sherman ◽

Lee Mchenry ◽

...

Keyword(s):

Cyst Fluid ◽

Pancreatic Cysts ◽

Fluid Analysis

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The Differentiation between Pancreatic Neoplastic Cysts and Pancreatic Pseudocyst

Scandinavian Journal of Surgery ◽

10.1177/145749690509400213 ◽

2005 ◽

Vol 94 (2) ◽

pp. 161-164 ◽

Cited By ~ 19

Author(s):

J. Sand ◽

I. Nordback

Keyword(s):

Pancreatic Pseudocyst ◽

Emission Tomography ◽

Cystic Lesions ◽

Imaging Studies ◽

Cystic Neoplasms ◽

Fluid Analysis ◽

Positron Emission ◽

Serous Cystadenomas ◽

History Of ◽

Quality Imaging

The number of small and often asymptomatic cystic lesions detected in pancreas has increased during the last decade. Historically the vast majority of the pancreatic cystic lesions were considered pseudocysts, but in recent series the incidence of various neoplastic cysts, such as intraductal papillary mucinous neoplasm, serous cystadenomas and cystic endocrine tumours, has increased. The possible malignant potential in these cystic neoplasms warrants careful diagnostic workup to choose the optimal treatment for each patient. Patient's age, symptoms and a possible history of acute or chronic pancreatitis with known aetiology together with high quality imaging studies are important in the differential diagnosis between pseudocysts and neoplastic cysts. Endoscopic ultrasound, cyst fluid analysis and positron emission tomography may be used in selected patients, but the accuracy of these methods needs further investigation.

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