Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Clinical Pathology, Rigshospitalet, Copenhagen, Denmark.
Surg Endosc. 2021 Dec;35(12):6650-6659. doi: 10.1007/s00464-020-08166-3. Epub 2020 Dec 1.
Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs.
The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard.
Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01).
EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma.
胰腺囊性病变（PCL）的影像学特征是一个已知的不确定性问题。本前瞻性研究的目的是比较内镜超声形态学、细胞学和囊液癌胚抗原（EUS-FNA-CEA）与横断面成像在切除的 PCL 中的诊断性能。
在一家学术性三级转诊中心，使用手术标本的组织学作为诊断标准，收集横断面成像和 EUS-FNA 的结果。
在 2007 年 2 月至 2017 年 3 月期间，对 289 例接受 PCL 横断面成像和 EUS-FNA 评估的患者进行了研究，其中 58 例行手术切除，最终诊断为 PCL：45 例黏液性、5 例浆液性、1 例假性囊肿、2 例内分泌、2 例实性假乳头状瘤和 3 例其他。EUS-FNA-CEA 在诊断黏液性 PCL 方面比横断面成像更准确（95%比 83%，p=0.04）。92%的高级别异型增生或腺癌的 PCL 直径小于 3cm。EUS-FNA-CEA 和横断面成像检测高级别异型增生或腺癌的 PCL 的敏感性分别为 33%和 5%（p=0.03），但两种方法的准确性无差异（62%比 66%，p=0.79）。EUS-FNA-CEA 检测胰腺腺癌的敏感性为 64%，而横断面成像的敏感性为 9%（p=0.03）。总体而言，EUS-FNA-CEA 比横断面成像为更多的 PCL 患者提供了正确的诊断（72%比 50%，p=0.01）。
EUS-FNA-CEA 准确，应作为 PCL 诊断的补充检查。然而，需要提高对高级别异型增生或腺癌的 PCL 的检测。囊肿大小似乎不是高级别异型增生或腺癌的可靠预测因子。
