Attasaranya Siriboon, Pais Shireen, LeBlanc Julia, McHenry Lee, Sherman Stuart, DeWitt John M
Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
JOP. 2007 Sep 7;8(5):553-63.
Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (EUS-FNA) has been increasingly utilized to differentiate malignant/pre-malignant pancreatic cysts from those that are benign or have low malignant potential.
To determine the utility of EUS morphology, EUS-FNA cytology and cyst fluid analysis to distinguish mucinous cystic neoplasms from non-mucinous cystic neoplasms based on histopathology following surgical resection.
A retrospective, single center case series.
Patients who underwent EUS and EUS-FNA of known or suspected pancreatic cysts followed by surgical resection. The final diagnosis was based on histopathology.
Patients were divided in two groups: mucinous cystic neoplasms and non-mucinous cystic neoplasms. Patients with intraductal papillary mucinous tumors were excluded.
Clinical profiles and EUS findings.
Forty-eight patients (mean age: 52 years; 29 females, 19 males) were identified: 16 mucinous cystic neoplasms and 32 non-mucinous cystic neoplasms. There were more women in the mucinous cystic neoplasm group compared to the non-mucinous cystic neoplasm group (88% vs. 47%; P=0.011) but the two groups were otherwise similar. The sensitivity, specificity and frequency of cases correctly identified of EUS-FNA cytology for the diagnosis of mucinous cystic neoplasms were 12.5% (95% CI: 2.2-37.2%), 90.6% (95% CI: 75.0-97.5%) and 64.6% (95% CI: 50.4-77.0%), respectively. Median cyst fluid CEA for the mucinous cystic neoplasm group (277 ng/mL; n=14) was significantly higher (P=0.002) than the non-mucinous cystic neoplasm group (1.5 ng/mL; n=21). Cyst fluid CEA greater than 800 ng/mL had a sensitivity of 42.9% (95% CI: 21.3-67.4%) and specificity of 95.2% (95% CI: 75.6-99.9%) for the diagnosis of mucinous cystic neoplasm. On the other hand, a cyst fluid CEA greater than a best cut-off ranging from 3.5 to 8.5 ng/mL had a sensitivity of 92.9% (95% CI: 66.5-100%), a specificity of 66.7% (14/21; 95% CI: 45.2-83.0%), and an accuracy of 81.1% with a frequency of cases correctly identified of 77.1% (95% CI: 60.7-88.2%).
EUS-FNA cytology and cyst fluid CEA greater than 800 ng/mL are insensitive but highly specific for differentiating mucinous cystic neoplasms from non-mucinous cystic neoplasms. EUS morphology alone cannot distinguish between the two groups.
内镜超声（EUS）联合EUS引导下细针穿刺抽吸术（EUS-FNA）已越来越多地用于鉴别恶性/癌前胰腺囊肿与良性或恶性潜能较低的囊肿。
根据手术切除后的组织病理学，确定EUS形态、EUS-FNA细胞学检查及囊液分析在鉴别黏液性囊性肿瘤与非黏液性囊性肿瘤中的作用。
一项回顾性单中心病例系列研究。
接受过已知或疑似胰腺囊肿的EUS及EUS-FNA检查，随后接受手术切除的患者。最终诊断基于组织病理学。
患者分为两组：黏液性囊性肿瘤组和非黏液性囊性肿瘤组。导管内乳头状黏液性肿瘤患者被排除。
临床特征及EUS检查结果。
共纳入48例患者（平均年龄52岁；女性29例，男性19例）：16例黏液性囊性肿瘤，32例非黏液性囊性肿瘤。黏液性囊性肿瘤组女性多于非黏液性囊性肿瘤组（88%对47%；P=0.011），但两组在其他方面相似。EUS-FNA细胞学检查诊断黏液性囊性肿瘤的敏感性、特异性及正确识别病例的频率分别为12.5%（95%CI：2.2-37.2%）、90.6%（95%CI：75.0-97.5%）和64.6%（95%CI：50.4-77.0%）。黏液性囊性肿瘤组囊液癌胚抗原（CEA）中位数（277 ng/mL；n=14）显著高于非黏液性囊性肿瘤组（1.5 ng/mL；n=21）（P=0.002）。囊液CEA大于800 ng/mL诊断黏液性囊性肿瘤的敏感性为42.9%（95%CI：21.3-67.4%），特异性为95.2%（95%CI：75.6-99.9%）。另一方面，囊液CEA大于最佳临界值3.5至8.5 ng/mL时，敏感性为92.9%（95%CI：66.5-100%），特异性为66.7%（14/21；95%CI：45.2-83.0%），准确率为81.1%，正确识别病例的频率为77.1%（95%CI：60.7-88.2%）。
EUS-FNA细胞学检查及囊液CEA大于800 ng/mL在鉴别黏液性囊性肿瘤与非黏液性囊性肿瘤时敏感性低但特异性高。单纯EUS形态无法区分这两组。
