Endosonography in the differentiation of neoplastic and nonneoplastic pancreatic cysts

BACKGROUND AND OBJECTIVES: Pancreatic cystic lesions (PCLs) are increasingly found in the clinical practice because of the widespread use of imaging modalities. Although differential diagnosis of nonneoplastic and neoplastic pancreas cysts is not certain markers, endosonography which has been taken place in cyst management shows morphologic specialty of cyst and cyst fluids by fine needle aspiration (FNA). Endoscopic ultrasound (EUS) and EUS-FNA performed patients were evaluated to pancreas cyst features for the differentiation of neoplastic or nonneoplastic. METHOD: Between January and July 2016, sixty patients with PCLs were retrospectively evaluated. Patients were recorded with undergoing pancreatitis, diabetes mellitus, and hematologic and biochemical parameters. EUS evaluation of PCLs was noted according to size, focal irregularity, wall thickness, and echo-dens mucus or debris. EUS FNA fluid was evaluated with biochemical (amylase, carcinoembryonic antigen, carbohydrate antigen 19-9) and cytology. RESULTS: Finally, 73.3% were nonneoplastic cases, whereas 26.7% were found to have malignant or premalignant. On comparing nonneoplastic and neoplastic groups, age (P = 0.002), alkaline phosphatase (P = 0.001), and g-glutamyl transferase (P = 0.004) were high and hematocrit (P = 0.001) and albumin (P = 0.001) were low in malignant groups. Of the non-neoplastic PCLs, 61.3% were atypical pseudocysts, 20.4% were serous cystadenomas, and 18.1% were simple cysts, whereas of the malignant PCLs, 26.7% was intraductal papillary mucinous neoplasms, 18% were mucinous cystic neoplasms, and 25% were adenocacinomas. The septation in the nonneoplastic group was 25% and in the neoplastic group was 56.2% (P = 0.023). Cyst lobulation was 25% in the nonneoplastic groups and 56.2% in the neoplastic group (P = 0.014). Mural nodularity was 2.5% in the nonneoplastic group and 26.7% in neoplastic group (P = 0.005). CONCLUSION: Majority of patients who needed EUS-FNA that EUS and clinical investigation were insufficient for final diagnosis were nonneoplastic. This situation is thought that the management of PCLs for clinician poses still problems. Although cholestasis findings in the malign PCLs are more common than the non-neoplastic group, EUS-FNA performed in this cholestasis group is thought helping to differentiation of between neoplastic and nonneoplastic situation. In our study, the presence of mural nodularity and cyst septation in PCLs were found effective in differentiation of pre-malign and benign as in other studies. In addition to, we think that cyst lobularity may help differentiation of neoplastic and nonneoplastic.