Introduction Preferred strategies for evaluation and management of patients with pancreatic cysts remain controversial. EUS-guided fine needle aspiration (FNA) of suspected pancreatic cyst tumours for CEA and cytology is often recommended to evaluate malignant potential in order to guide further management.
Aim To evaluate the clinical impact of EUS guided cyst aspirate on surgical management of patients with suspected pancreatic cystic tumours.
Methods Outcome data of all patients having undergone EUS guided FNA of suspected pancreatic cystic tumours from March 2004 to November 2011 were retrospectively reviewed. Data were collected on demographics, EUS findings, radiological findings, biochemical and cytological findings, clinical outcomes and management. The mean follow-up was 24.5 months.
Results Of 123 patients (74F:49M; 64±2.7 years) with suspected pancreatic cystic tumours, only 10 (8%) patients had surgical resection for IPMN with low grade dysplasia (n=7), MCN (n=1), pancreatic neuroendocrine tumour (n=1) and serous cystadenoma (n=1). Only 3(12%) patients with CEA >192 μg/l and 1 (7%) with CA 19–9 >1000 U/l had surgery. Similarly only 3 (30%) with abnormal cytology were considered for surgery. Although most patients (n=9) who underwent surgery were symptomatic, 18/113 (16%) patients in the conservatively managed group also had symptoms related to the cystic tumours. The size of the cystic tumour in the surgical group, however, was significantly larger than that in the conservative group (4.9 cm vs 2.9 cm, p<0.01).
Conclusion Surgical decision making process in patients with pancreatic cystic lesions is complex with multiple factors influencing the choice of surgery. Our data indicate the limited role of pancreatic fluid analysis compared with symptoms and cyst size. Factors that guide and influence the need for surgical resection of pancreatic cystic tumours should be further evaluated.
Competing interests None declared.
Reference 1. Khalid A, Brugge W. Practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 2007;102:2339–49.
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