A second endoscopic ultrasound with fine‐needle aspiration for cytology identifies high‐risk pancreatic cysts overlooked by current guidelines

A second endoscopic ultrasound with fine‐needle aspiration for cytology identifies high‐risk pancreatic cysts overlooked by current guidelines:

Abstract

Background

Endoscopic ultrasound with fine‐needle aspiration (EUS‐FNA) is recommended for diagnosis of pancreatic cystic lesions (PCLs). Its role in surveillance is unclear. Our goal was to determine if a second EUS‐FNA changes diagnosis or management of PCLs.

Methods

A retrospective analysis of an EUS database, searching for EUS‐FNAs in PCLs from 2007 to 2017 was performed. Demographics, cyst characteristics, and FNA results were compared in patients under surveillance, performing a single or two consecutive EUS‐FNAs.

Results

Of 203 PCLs referred for EUS‐FNA, surveillance was decided in 128 (63%). Data of 105 (82%) patients with a single EUS‐FNA were compared with 23 (18%) with two EUS‐FNAs during surveillance. Patients were younger in this latter group (P = .055), whereas CEA levels were marginally higher (P = .078) and a mass/nodule were more frequent (P = .006). The mean time between EUS‐FNAs was 38 months (4.7‐118.8) for 18 patients maintaining surveillance vs 18 months (2.9‐56.9) in the four referred for surgery (P = NS) after two EUS‐FNAs (two NETs, one IPMN‐HGD, and one MCN‐LG). A high correlation in CEA level between consecutive EUS‐FNAs (r
² = 0.945, P < .01) was present, with a change of category observed (cut‐off level = 192 ng/mL) in two patients only. Of four patients with a second EUS‐FNA with conclusive cytology, two had NETs confirmed on resection.

Conclusions

Repeating EUS‐FNA in surveillance of PCLs with clinical suspicion of malignancy increased neoplasm diagnoses, changing decision toward surgery in almost 20% of patients while excluding IPMNs with mucin nodules from unnecessary resections. A second EUS‐FNA for cytology appears justified in some PCLs, particularly for diagnosing NETs.