Clinical-liver, pancreas, and biliary tractDiagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study☆
Section snippets
Materials and methods
A multicenter trial, with institutional review board approval at each site, was initiated in July 1999 (see Appendix I). Patients (with or without symptoms) found to have a pancreatic cystic lesion of greater than 10 mm on transabdominal ultrasonography or computed tomography (CT) scanning were eligible. Exclusion criteria included the following: Protime (PT-INR) >1.5, partial thromboplastin time (PTT) >50, platelets <50,000, acute pancreatitis, or the presence of a pancreatic abscess. The
EUS methods
All patients underwent an EUS examination, performed using a linear echoendoscope as previously described.16 The results of the examination prospectively reported the location, size, and morphology (see below) of the cystic lesion. The cystic lesion was aspirated under EUS guidance using 1 passage of a 19- or 22-gauge needle (Wilson Cook Inc., Winston-Salem, North Carolina; or Mediglobe, Tempe, AZ) occluded with a stylet. An oral quinolone was administered for 2–3 days after the procedure.
Results
Three hundred forty-one consecutive patients were enrolled in the trial over 2 years and underwent EUS and FNA. None of the patients had an infective complication of the EUS-guided FNA. Two patients developed mild pancreatitis after the EUS-FNA that resolved within 3 days.
The patient characteristics are presented in Table 1. Patients were predominantly female (63%, P < 0.001). Most of the cysts examined (n = 207, 61%) were greater than 2 cm in diameter, and most were located in the head of the
Discussion
Cystic mucinous neoplasms of the pancreas are composed of a group of cystic tumors that are lined by mucinous, columnar epithelium. The diagnosis of this type of cystic lesion is very important because of the presence of malignancy in some lesions at the time of presentation and the tendency to develop malignancy over time. This feature is highlighted in our highly selected patients by the presence of malignancy or borderline malignancy in 40 of 68 patients with a mucinous cystic lesion. Other
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Supported by the American Society of Gastrointestinal Endoscopy (ASGE) and a career development award from the ASGE (to W.R.B.).
None of the investigators have a financial conflict of interest with the corporations referred to in this study.