Diagnosis parameters in pancreatic cystic neoplasms: Single center experience

Introduction and Objective The identification frequency of pancreatic cystic lesions are increasing day by day due to the widespread use of cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI). Pancreatic cystic lesions are simply divided into two main classes: non-neoplastic (eg: pseudocysts) and neoplastic cysts. Managing the treatment of pancreatic cystic lesions (PCLs) is difficult for the clinician; therefore, in order to make differantial diagnosis; medical history, clinical, laboratory, radiological imaging, EUS, evaluation of cyst fluid analysis and cytopathology data obtained with EUS-FNA is important. The objective of this study was to investigate clinical, laboratory, radiological, endoscopic ultrasound and pathological examinations of the pancreatic cystic neoplasms by comparing the diagnostic contribution with pseudocysts. Materials and Methods 30 patients who underwent surgical operation and were diagnosed pathologic "neoplastic cyst" of PCLs with EUS/EUS-FNAB evaluation in the gastroenterology clinic of the Dokuz Eylül Medical Faculty (DEUMF) between July 2009 and August 2017 with 46 patients who history of acute pancreatitis with a diagnosis of ''pseudocyst'' were included in the EUS reports after evaluation of EUS / EUS-FNAB with PCLs, were icluded in the study. The demographic characteristics of the patients, clinical features, laboratory data, radiological / EUS image reports and pathological examination results were investigated retrospectively. Results Surgical pathology results of 30 patients for PCLs were IPMN in 15 patients (%50), cystic adenocarcinoma in 6 patients (%13), SPPN in 4 patients (%13,3), MKN in 3 patients (10%) and SCN in 2 patients (%6,7). In the EUS; when the morphological characteristics of the pancreas and cysts are examined; 2 patients (%6,7) in the neoplastic cyst group had chronic pancreatitis, 6 patients (%20) had expansion in main pancreatic duct, 2 patients (%6,7) had enlarged in the side branch pancreatic duct, 6 patients (%20) had cysts were associated with the pancreatic duct, 9 patients (%30) had septation, 5 patients (% 16,7) had lobularity, 5 patients (% 16,7) had calcification, 4 patients (% 13,3) had thick of the cyst wall. As for in the pseudocyst group; 1 patient (%2,2) had septation and 1 patient (%2,2) had lobularity. İn cyst fluid analysis with EUS-FNAB: in the cyst analysis of the neoplastic cyst group mean amylase was 28,808,8 ± 60,961,01 U / L and mean CEA value was 1.055,29 ± 1,548,14 ng / mL; in the cyst analysis of the pseudocyst group mean amylase value was 28.246,13 ± 29.858,56 U / L and mean CEA value was 7,31 ± 10,02 ng / mL. EUS diagnosed 13 (%43,3) of the neoplastic cysts correctly. In mucinous cysts; when we add the diagnostic discrimination of EUS to any of the EUS-FNAB findings (cytopathology, mucin, string sign and CEA> 192 ng / mL) or all of them positive, the diagnostic sensitivity reaches up to %88,9. Discussion and Suggestions In the diagnosis of neoplastic cysts of the pancreas; EUS and EUS-FNAB are the method with the highest diagnostic sensitivity. However, up to %15 is not sufficient to distinguish neoplastic / benign cyst. Its use with radiological methods increases diagnostic accuracy. Serum CA 19-9 levels in diabetic patients with pancreatic cysts may be helpful in diagnose neoplastic cyst. Key words: pancreas, pseudocyst, cyst, neoplasi, diagnosis, endoscopic ultrasonography