Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, Hong Kong, China.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Endosc Ultrasound. 2014 Apr;3(2):82-90. doi: 10.4103/2303-9027.124307.
Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is an established diagnostic tool in the management of pancreatic cystic lesions (PCLs). Due to the proximity to the target lesion, the fine diagnostic needle travels through only minimal normal tissues. The risks of bleeding, pancreatitis and infection are small. Valuable diagnostic morphological information can be obtained by EUS before the use of FNA. The additional cytopathologic and cyst fluid analysis for the conventional markers such as amylase, carcinoembryonic antigen (CEA) and CA19.9 improves the diagnostic capability. Pancreatic cyst fluid CEA concentration of 192 ng/mL is generally the most agreed cutoff to differentiate mucinous from non-mucinous lesion. A fluid amylase level of <250 IU/L excludes the diagnosis of pseudocyst. Technical tips of EUS-FNA and the limitations of the procedure are discussed. Promising technique and FNA needle modifications have been described to improve the diagnostic yield at the cytopathologic analysis. The use of novel cyst fluid proteomics and deoxyribonucleic acid-based biomarkers of the PCLs are reviewed. Although it is considered a safe procedure, EUS-FNA is not a routine in every patient. Recommendations of the role of EUS-FNA at various common clinical scenarios are discussed.
内镜超声（EUS）引导下细针抽吸（FNA）是胰腺囊性病变（PCL）管理中一种成熟的诊断工具。由于靠近目标病变，细诊断针仅穿过最小的正常组织。出血、胰腺炎和感染的风险很小。在使用 FNA 之前，EUS 可以获得有价值的诊断形态学信息。通过对常规标志物（如淀粉酶、癌胚抗原（CEA）和 CA19.9）进行额外的细胞病理学和囊液分析，可以提高诊断能力。胰腺囊液 CEA 浓度为 192ng/ml 通常是区分黏液性和非黏液性病变的最一致的截止值。液体淀粉酶水平<250IU/L 可排除假性囊肿的诊断。讨论了 EUS-FNA 的技术要点和该程序的局限性。已经描述了有前途的技术和 FNA 针的改进，以提高细胞病理学分析的诊断产量。还回顾了胰腺囊性病变新型囊液蛋白质组学和基于脱氧核糖核酸的生物标志物的应用。尽管它被认为是一种安全的程序，但 EUS-FNA 并不是每个患者的常规程序。讨论了在各种常见临床情况下 EUS-FNA 的作用建议。
