Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions

Lawrence A. Shirley, Jon Walker, Somashekar Krishna, Samer El-Dika, Peter Muscarella, E. Christopher Ellison, Carl R. Schmidt, Mark Bloomston

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making. Materials and Methods: Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection. Results: A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration. Discussion: In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.

Original languageEnglish (US)
Pages (from-to)1581-1585
Number of pages5
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Cyst Fluid
Cell Biology
Pancreatic Cyst
Amylases
Surgical Pathology
Mucins
Fine Needle Biopsy
Pancreas
Ultrasonography

Keywords

  • Amylases
  • Carcinoembryonic antigen
  • Cytology
  • Pancreatic cysts
  • Pancreatic neoplasms

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions. / Shirley, Lawrence A.; Walker, Jon; Krishna, Somashekar; El-Dika, Samer; Muscarella, Peter; Ellison, E. Christopher; Schmidt, Carl R.; Bloomston, Mark.

In: Journal of Gastrointestinal Surgery, Vol. 20, No. 9, 01.09.2016, p. 1581-1585.

Research output: Contribution to journalArticle

Shirley, LA, Walker, J, Krishna, S, El-Dika, S, Muscarella, P, Ellison, EC, Schmidt, CR & Bloomston, M 2016, 'Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions', Journal of Gastrointestinal Surgery, vol. 20, no. 9, pp. 1581-1585. https://doi.org/10.1007/s11605-016-3175-2
Shirley, Lawrence A. ; Walker, Jon ; Krishna, Somashekar ; El-Dika, Samer ; Muscarella, Peter ; Ellison, E. Christopher ; Schmidt, Carl R. ; Bloomston, Mark. / Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions. In: Journal of Gastrointestinal Surgery. 2016 ; Vol. 20, No. 9. pp. 1581-1585.
@article{c1afa2d343c24885b65f26ed0d3cf826,
title = "Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions",
abstract = "Background: The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making. Materials and Methods: Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection. Results: A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 {\%} of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration. Discussion: In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.",
keywords = "Amylases, Carcinoembryonic antigen, Cytology, Pancreatic cysts, Pancreatic neoplasms",
author = "Shirley, {Lawrence A.} and Jon Walker and Somashekar Krishna and Samer El-Dika and Peter Muscarella and Ellison, {E. Christopher} and Schmidt, {Carl R.} and Mark Bloomston",
year = "2016",
month = "9",
day = "1",
doi = "10.1007/s11605-016-3175-2",
language = "English (US)",
volume = "20",
pages = "1581--1585",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions

AU - Shirley, Lawrence A.

AU - Walker, Jon

AU - Krishna, Somashekar

AU - El-Dika, Samer

AU - Muscarella, Peter

AU - Ellison, E. Christopher

AU - Schmidt, Carl R.

AU - Bloomston, Mark

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background: The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making. Materials and Methods: Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection. Results: A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration. Discussion: In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.

AB - Background: The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making. Materials and Methods: Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection. Results: A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration. Discussion: In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.

KW - Amylases

KW - Carcinoembryonic antigen

KW - Cytology

KW - Pancreatic cysts

KW - Pancreatic neoplasms

UR - http://www.scopus.com/inward/record.url?scp=84970016084&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84970016084&partnerID=8YFLogxK

U2 - 10.1007/s11605-016-3175-2

DO - 10.1007/s11605-016-3175-2

M3 - Article

VL - 20

SP - 1581

EP - 1585

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 9

ER -