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.

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.

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.

scholarly journals Survival in Cystic Neoplasms of the Pancreas

2009 ◽  
Vol 23 (8) ◽  
pp. 537-542 ◽  
Author(s):  
Ali Cadili ◽  
Amy Bazzerelli ◽  
Sipi Garg ◽  
Robert Bailey
Keyword(s):  
Overall Survival ◽  
Pancreatic Cyst ◽  
Patient Survival ◽  
Survival Rates ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Patient Age ◽  
Patient Âgé ◽  
History Of ◽  
Pancreatic Cystic Neoplasms

BACKGROUND: The natural history of pancreatic cystic neoplasms remains poorly understood despite growing evidence on the subject. Pancreatic cysts display a wide spectrum of pathological phenotypes, each associated with a different prognostic implication. Many pancreatic cysts are of undetermined malignant potential at presentation and remain so until surgically resected. While the survival rates of patients with malignant cysts are known to be poor, survival rates in patients with undetermined pancreatic cysts are unknown.OBJECTIVE: To identify the factors associated with survival in a group of patients diagnosed with a pancreatic cyst(s).METHODS: The present study was a retrospective multicentre review of pancreatic cystic neoplasms. All patients with a diagnosis of a neoplastic pancreatic cyst from 1994 to 2003 were identified at five different institutions in Edmonton, Alberta. The data collected included patient age, sex, imaging modality, cyst location, cyst size, number of cysts, comorbid illnesses, history of upper abdominal surgery, previous cancer, previous or concurrent metastases, symptoms (pain, upper gastrointestinal bleeding, signs of biliary obstruction, nausea/vomiting), remarkable radiological features, elevated amylase or lipase, type of pancreatic surgery, final pathology (benign or malignant) and overall survival. Survival models were used to assess whether any covariates were predictors of the survival time. Patient data were plotted using the Kaplan-Meier method. The resulting plot was used to calculate survival in the cohort.RESULTS: In total, 64 patients were identified as having neoplastic pancreatic cysts from 1994 to 2003 at the five institutions. The median overall patient survival time was 86 months. The median age at diagnosis for the patient population was 73 years, with 40 patients being women. Univariate analysis revealed that the risk of death was associated with patient age, sex and history of major comorbid illness. Multivariate models identified increased patient age and male sex as the factors that correlated most strongly with decreased overall survival.CONCLUSION: Overall survival in patients with neoplastic pancreatic cysts is determined by patient factors (ie, age and sex) rather than factors descriptive of the cyst such as size and morphology. No conclusions could be made regarding the relationship between cyst pathology and patient survival.

Pancreatic cystic neoplasms: the role and sensitivity of needle aspiration and biopsy

1998 ◽  
Vol 23 (4) ◽  
pp. 387-393 ◽  
Author(s):  
S. K. Carlson ◽  
C. D. Johnson ◽  
K. R. Brandt ◽  
K. P. Batts ◽  
D. R. Salomao
Keyword(s):  
Needle Aspiration ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms

The Role of Molecular Analysis in Pancreatic Cystic Neoplasms

2009 ◽  
Vol 69 (5) ◽  
pp. AB239
Author(s):  
Tamas A. Gonda ◽  
Peter S. Francisco ◽  
Shashin Shah ◽  
Vasudha Dhar ◽  
Charles J. Lightdale ◽  
...  
Keyword(s):  
Molecular Analysis ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms

scholarly journals Prognostic Role of Tissue and Circulating MicroRNA-200c in Malignant Tumors: a Systematic Review and Meta-Analysis

2015 ◽  
Vol 35 (3) ◽  
pp. 1188-1200 ◽  
Author(s):  
Yingjie Shao ◽  
Yiting Geng ◽  
Wendong Gu ◽  
Jin Huang ◽  
Honglei Pei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Malignant Tumors ◽  
Early Stage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Circulating Microrna ◽  
Prognostic Role ◽  
Altered Expression ◽  
High Level

Background: Recently, many studies have shown that microRNAs (miRNA) exhibit altered expression in various cancers and may serve as prognostic biomarkers. We performed a systematic review and meta-analysis to evaluate the prognostic role of miR-200c expression in different cancers. Methods: Studies were recruited by searching PubMed, Embase and the Cochrane Library (last search update was May 2014) and assessed by further quality evaluation. Results: A total of 25 studies dealing with various carcinomas were identified for systematic review. Among them, 18 studies were ultimately included in the meta-analysis. Our results indicated that the expression of tissue miR-200c was not associated with OS and PFS in various carcinomas; however, downregulation of tissue miR-200c did predict poor OS of patients with stage I disease (HR=0.41, 95% CI 0.25-0.68, P=0.001). Furthermore, overexpression of blood miR-200c was significantly related to poor OS and PFS (HR=3.07 95% CI 1.58-5.96 P=0.001, HR=2.26 95% CI 1.66-3.08 P<0.001, respectively), especially in patients with advanced disease. Conclusion: This systematic review and meta-analysis clarified that low expression of miR-200c in primary tissue was significantly associated with poor survival in cancer patients at early stage, whereas a high level of blood miR-200c predicted poor prognosis in patients with advanced tumors.

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