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Predicting success of endoscopic aspiration for suspected pancreatic cystic neoplasms
R Matthew Walsh1, Gregory Zuccaro, John A Dumot
1Department of Hepatobiliary Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. walshm@ccf.org
Context:
Analysis of pancreatic cyst fluid can play a role in the management of asymptomatic cystic neoplasms.
Objective:
Our aim was to determine whether cyst size or location can predict the success of cyst fluid collection and analysis.
Design:
Review of prospective management protocol.
Setting:
Tertiary care referral center.
Patients:
Three-hundreds and 70 patients with suspected pancreatic cystic neoplasms evaluated over 6 years.
Interventions:
Endoscopic ultrasound aspiration for up to 3 variables: cytology including extracellular mucin, CEA, and amylase.
Main Outcome Measures:
The number of variables obtained were compared with cyst size and location.
Results:
The distribution of unilocular cystic lesions was: 125 (33.8%) head, 105 (28.4%) tail, 77 (20.8%) body, 37 (10.0%) uncinate and 13 (3.5%) multiple cysts. In addition, 13 (3.5%) patients had uncertain cyst location. There was no association between cyst location and number of variables obtained (P=0.148). An aspirate was obtained in 284 patients (76.8%) with a mean volume of 8.3 mL. There was a significant correlation between cyst size and volume aspirated (P<0.001). The number of variables obtained was significantly correlated with cyst size (P<0.001): 3 variables were obtained in 109 out of 284 (38.4%) with a median size of 3.0 cm. Logistic regression curves predict likelihood of success based on cyst size. An unsuccessful attempt at EUS aspiration for cysts occurred in 31 of the 284 cases (10.9%) with a median size of 1.5 cm.
Conclusions:
Successful endoscopic ultrasound aspiration of pancreatic cysts is independent of cyst location, but correlates with size, which can be useful in deciding which patients should undergo endoscopic ultrasound and aspiration.
