Clinical Utility of the Contrast-Enhanced Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Cyst
Miruna Patricia Olar,
Sorana D. Bolboacă,
Cristina Pojoga,
Ofelia Moșteanu,
Marcel Gheorghiu,
Radu Seicean,
Ioana Rusu,
Zeno Sparchez,
Nadim Al Hajjar,
Andrada Seicean
Affiliations
Miruna Patricia Olar
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Sorana D. Bolboacă
Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania
Cristina Pojoga
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Ofelia Moșteanu
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Marcel Gheorghiu
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Radu Seicean
First Department of Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, Clinicilor Str., no. 3-5, 400006 Cluj-Napoca, Romania
Ioana Rusu
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Zeno Sparchez
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Nadim Al Hajjar
Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Andrada Seicean
Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Endoscopic ultrasound fine needle aspiration (EUS-FNA) cytology from an intracystic fluid is useful in the differentiation of pancreatic cysts, with low sensitivity, which increases when the solid component is targeted. The clinical utility of contrast-enhanced guided EUS-FNA (CH-EUS-FNA) in the solid component is not known. We aimed to assess the diagnostic value of CH-EUS-FNA in enhanced mural nodules and discrimination between different cysts using contrast-enhanced endoscopic ultrasound (CH-EUS). The prospective study recruited patients with pancreatic cysts with an unclear diagnosis. The CH-EUS was followed by CH-EUS-FNA. The final diagnosis was based on surgery or the correlation between clinical history, cross-sectional imaging, echoendoscopic morphology, cystic fluid analysis, and follow-up. Fifty-eight patients with pancreatic cysts were evaluated. The mucinous cysts had wall arterial enhancement more often than non- mucinous cysts (p < 0.0001), with 90.2% sensitivity and 70.6% specificity. The CH-EUS-FNA from cystic fluid and mural nodules identified mucinous cysts and malignancy with 82.4% and 84.2% sensitivity and 92% and 100% specificity. Twenty-one cysts had solid components, but only 13 were enhanced mural nodules on EUS assessment with conclusive cytology in all cases and malignancy in 76.9%. Contrast-enhanced endoscopic ultrasound should be completed in all PCN with solid components in order to avoid unnecessary EUS-FNA and to guide FNA for the identification of malignant cysts.
