Determining when endoscopic ultrasound (EUS) changes management for patients with pancreatic cystic neoplasms.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 641-641
Author(s):  
Hasrit Sidhu ◽  
Khaola Maher ◽  
Dave Farnell ◽  
Leo Chen ◽  
Ian Gan ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Management ◽  
High Specificity ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Pancreatic Cystic Neoplasms ◽  
Low Sensitivity ◽  
Ct And Mri

641 Background: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to the widespread use of CT and MRI. CT and MRI cannot always differentiate between malignant and benign PCNs. EUS is an emerging tool that provides higher quality descriptions of pancreatic cysts and can be used to differentiate between benign and malignant features. Considering that EUS is a resource dependent tool, we hope to identify the PCN cases in which EUS changes management. Methods: We conducted a retrospective case-control chart review evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS for analysis between January 1, 2010 and December 31, 2017. We determined whether EUS correctly identified high-risk features (HRFs) relative to CT/MRI and whether EUS upstaged or downstaged the CT/MRI diagnosis to change overall patient management. Results: EUS was found to have a high specificity (> 95%) for all high-risk features identified in the AGA and FG guidelines and a low sensitivity ( < 70%) for all high risk features except cyst size > 3cm (82.35%) and mural nodule < 5mm (100%). EUS was found to change management in 29.4% of cases (18.2% upstaged, 11.2% downstaged). EUS screening led to a total of three adenocarcinoma diagnoses, in which two were reported to be invasive. Conclusions: The high specificity of EUS supports its use in the differentiation of high risk PCNs identified on cross-sectional imaging. Its low sensitivity indicates that the reliance on operator experience may be a substantial limitation resulting in inconclusive diagnoses. In conclusion, considering that EUS is successful in changing patient management of PCNs, it should be readily referred when any HRF is identified on cross-sectional imaging.

The Outcome of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Cystic Neoplasms: A Systematic Review

2020 ◽  
pp. 1-6
Author(s):  
Viswanath YKS ◽  
Ahmed Mehanna ◽  
Viswanath YKS ◽  
Talvinder Gill ◽  
Anil Reddy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Malignant Tumors ◽  
High Specificity ◽  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms ◽  
Low Sensitivity ◽  
The Uk

Introduction: Pancreatic cancer is the sixth most common cause of death from cancer in the UK. Cystic pancreatic neoplasms are being recognized more with the increase in the use of the CT scan. EUS has been increasingly used to asses and identify lesions in the pancreas, however, it can’t differentiate between benign and malignant tumors alone. The role of EUS guided FNA cytology (EUS FNAC) is still controversial in the management of pancreatic cysts where neoplastic process is questioned. Aim: This systematic review is aiming to explore the currently available evidence assessing the role of EUS guided FNA cytology (EUS FNAC) in the management of pancreatic cystic neoplasms. Methods: A total of five studies with 597 patient EUS FNAC episodes were included in this systematic review. Results: The sensitivity of the EUS FNAC in the papers was variable between 46.7% to 91.7% while the sensitivity of the test was 100% for all the papers except for 1 paper which was 82.1%. CEA level was assessed in 3 papers, however, the cut off level was different. Conclusion: The high specificity of EUS FNAC qualify it as a useful adjunct to ascertain or exclude malignancy in the pancreatic cystic lesions. EUS FNAC cannot be used alone as a method of screening, given low sensitivity. Measuring CEA in the cyst fluid can be a good aide to increase the sensitivity and an identifiable cut off level should be proposed. Well-conducted and powered studies are needed to further explore the role of EUS FNAC in patients with pancreatic cystic neoplastic lesions.

Case 12

2020 ◽  
pp. 73-80
Author(s):  
Bridget Atkins
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Tests ◽  
Lower Respiratory Tract ◽  
Patient Management ◽  
Supportive Therapy ◽  
Antimicrobial Treatment ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Low Sensitivity ◽  
Lung Infiltrates

Lung infiltrates in immunocompromised patients have a broad differential diagnosis. Assessment should include considering host risk factors, the clinical presentation, and imaging. Cross-sectional imaging is very helpful and lower respiratory tract samples should be obtained where possible. Laboratory diagnostic tests should be performed but most have low sensitivity and specificity. The differential diagnosis includes non-infective and infective cause. Effective patient management requires good supportive therapy if in respiratory failure, prompt diagnostics, early empiric antimicrobial treatment, and management of the underlying immunosuppression.

scholarly journals Interdisciplinary Management of Cystic Neoplasms of the Pancreas

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Linda S. Lee ◽  
Thomas Clancy ◽  
Vivek Kadiyala ◽  
Shadeah Suleiman ◽  
Darwin L. Conwell
Keyword(s):  
Wide Spectrum ◽  
Interdisciplinary Approach ◽  
Premalignant Lesions ◽  
Pancreatic Cysts ◽  
Interdisciplinary Management ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Frequent Use ◽  
Pancreatic Cystic Neoplasms ◽  
Pathologic Analysis

Cystic neoplasms of the pancreas are increasingly recognized due to the frequent use of abdominal imaging. It is reported that up to 20% of abdominal cross-sectional scans identify incidental asymptomatic pancreatic cysts. Proper characterization of pancreatic cystic neoplasms is important not only to recognize premalignant lesions that will require surgical resection, but also to allow nonoperative management of many cystic lesions that will not require resection with its inherent morbidity. Though reliable biomarkers are lacking, a wide spectrum of diagnostic modalities are available to evaluate pancreatic cystic neoplasms, including radiologic, endoscopic, laboratory, and pathologic analysis. An interdisciplinary approach to management of these lesions which incorporates recent, specialty-specific advances in the medical literature is herein suggested.

scholarly journals Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk

2018 ◽  
Vol 51 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Aline Falqueto ◽  
Gustavo Lemos Pelandré ◽  
Mariânges Zadrozny Gouvêa da Costa ◽  
Marcelo Souto Nacif ◽  
Edson Marchiori
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Pancreatic Cysts ◽  
Resonance Imaging ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Malignancy Risk ◽  
Pancreatic Cystic Neoplasms

Abstract Objective: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. Materials and methods: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. Results: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. Conclusion: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

scholarly journals Large cystic lympangioma of the pancreas: a case reportum

2018 ◽  
Vol 100 (1) ◽  
pp. e12-e14
Author(s):  
SN Jayappa ◽  
P Rao ◽  
AS Tandon ◽  
KGS Bharathy ◽  
SS Sikora
Keyword(s):  
Case Report ◽  
Cystic Mass ◽  
Careful Evaluation ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Pancreatic Cystic Neoplasms ◽  
Sectional Imaging ◽  
Pancreatic Origin

Lymphangioma of the pancreas is rare and presents as a large cystic mass in the retroperitoneum. The pancreatic origin can be confirmed by careful evaluation of cross sectional imaging. Preoperative differentiation from other pancreatic cystic neoplasms is difficult but possible. Large symptomatic lesions warrant surgery. The diagnosis is confirmed by typical features on histopathology and immunohistochemistry. Presented here is a case report of a pancreatic lymphangioma, discussed in the context of available literature.

scholarly journals Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

2020 ◽  
Vol 06 (02) ◽  
pp. e128-e130
Author(s):  
Shiva Poola ◽  
Shachar Laks ◽  
Peter Kragel ◽  
Kara Regan
Keyword(s):  
High Risk ◽  
Pancreatic Cyst ◽  
Imaging Techniques ◽  
Accessory Spleen ◽  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cross Sectional ◽  
Intrapancreatic Accessory Spleen ◽  
Cross Sectional Imaging ◽  
Magnetic Resonance Imaging Mri

AbstractIncidentally discovered pancreatic cysts have become more common with increasing use of abdominal cross-sectional imaging. Tools that help us to better risk stratify a pancreatic cyst include advanced imaging techniques, such as pancreatic protocol computed tomography (CT) scan or magnetic resonance imaging (MRI) with cholangiopancreatography. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are invasive measures to better define and sample cysts especially if high-risk features are present. EUS may also yield pancreatic cyst fluid for analysis of carcinoembryonic antigen (CEA) which is elevated in mucinous cysts. This case highlights a rare finding of a mucinous, epidermoid cyst in an intrapancreatic accessory spleen (IPAS) with high-risk features on EUS.

The role of pre-biopsy mpMRI in lymph node staging for prostate cancer

2021 ◽  
pp. 039156032110168
Author(s):  
Nassib Abou Heidar ◽  
Robert El-Doueihi ◽  
Ali Merhe ◽  
Paul Ramia ◽  
Gerges Bustros ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Gleason Score ◽  
Gold Standard ◽  
Cross Sectional ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Kappa Agreement

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

scholarly journals Management Guidelines for Pancreatic Cystic Lesions: Should we Adopt or Adapt the Current Roadmaps?

2019 ◽  
Vol 28 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Filipe Vilas-Boas ◽  
Guilherme Macedo
Keyword(s):  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
International Consensus ◽  
Cross Sectional ◽  
Fluid Analysis ◽  
Mucinous Neoplasms ◽  
Cross Sectional Imaging ◽  
History Of ◽  
International Consensus Guidelines

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

scholarly journals Pancreatic Cysts

2016 ◽  
Vol 46 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Timothy Meagher ◽  
Andreas Armuss
Keyword(s):  
Malignant Transformation ◽  
Abdominal Imaging ◽  
The Other ◽  
Pancreatic Cysts ◽  
Risk Selection ◽  
Optimal Management ◽  
Ongoing Debate ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms ◽  
Benign Course

Pancreatic cysts are more common than before, largely because of widespread abdominal imaging. Pancreatic cystic neoplasms (PCN) are relevant to risk selection on 2 counts: they constitute more than 50% of all pancreatic cysts and, in contrast to the other 2 cyst types, are capable of malignant transformation. The majority of PCNs are benign at time of diagnosis and will follow a benign course. The challenge is to identify those PCNs that are malignant or will undergo malignant transformation with time. The purpose of this article is to provide pointers that can help meet this challenge while also summarizing the ongoing debate about their optimal management.

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