Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in Evaluating Pancreatic Cystic Lesions. A Single Center Experience

Introduction: Cystic lesions of pancreas are increasingly being recognized with improved and more frequent imaging. However, it is often difficult to differentiate between different cystic lesions of the pancreas despite the various imaging modalities. The purpose of this study is to assess the role of Endoscopic Ultrasound (EUS-FNA) to differentiate different cystic lesions of the pancreas. Methods: Results of EUS-FNA of pancreatic cystic lesions done at our institution from October 2003 to October 2005 were reviewed. 22-gauge needle was used to perform EUS- FNA. All the patients received prophylactic antibiotics. Cyst fluid was evaluated for cytology, CEA, lipase and amylase levels. Results: A total of 102 patients identified and analysed. This included 35 males (34.31%) and 67 female (65.69%). EUS-FNA was performed in all the 102 patients. The EUS-FNA results are as shown in the table 1. FNA results which were reported as negative for malignancy (14) are classified as under uncertain diagnosis. Diagnosis was made in 84 patients (82.35%). Only 1 patient had a complication (0.98%) and it was acute pancreatitis.

Pancreatic Adenocarcinoma	13 (12.74%)
Mucinous cystadenocarcinoma	7 (6.86%)
Neuroendocrine tumors	3 (2.9%)
Mucinous cystadenoma	9 (8.9%)
Serous Cystadenoma	11 (10.7%)
Pseudocyst	41 (40.19%)
Uncertain diagnosis	14 (13.72%)
Inadequate sample	4 (3.9%)

Table 1. Cytopathology results of EUS-FNA performed on cystic pancreatic lesions

Conclusion: EUS-FNA is safe, minimally invasive and valuable for differentiating pancreatic cystic lesions. Improvement in techniques to prepare and analyse cyst fluid are needed to improve EUS-FNA performance.