Endosonography in the diagnosis and management ofpancreatic cysts

• 作者: Linda S Lee Vivek Kadiyala
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic ultrasound Pancreatic cyst SEROUS CYSTADENOMA INTRADUCTAL papillary mucinousneoplasms MUCINOUS CYSTIC neoplasm Solid pseudopapillaryneoplasms diagnosis Management Ablation
• 年，卷（期）: 2015,（3）
• 页码范围: 213-223
• 页数: 11页
• 分类号: R

摘要

Rapid advances in radiologic technology and increasedcross-sectional imaging have led to a sharp rise inincidental discoveries of pancreatic cystic lesions.These cystic lesions include non-neoplastic cysts withno risk of malignancy, neoplastic non-mucinous serouscystadenomas with little or no risk of malignancy,as well as neoplastic mucinous cysts and solidpseudopapillary neoplasms both with varying riskof malignancy. Accurate diagnosis is imperative asmanagement is guided by symptoms and risk ofmalignancy. Endoscopic ultrasound （EUS） allows highresolution evaluation of cyst morphology and preciseguidance for fine needle aspiration （FNA） of cyst fluidfor cytological, chemical and molecular analysis. Initially,clinical evaluation and radiologic imaging, preferablywith magnetic resonance imaging of the pancreas andmagnetic resonance cholangiopancreatography, areperformed. In asymptomatic patients where diagnosisis unclear and malignant risk is indeterminate, EUSFNAshould be used to confirm the presence orabsence of high-risk features, differentiate mucinousfrom non-mucinous lesions, and diagnose malignancy.After analyzing the cyst fluid for viscosity, cyst fluidcarcinoembryonic antigen, amylase, and cyst wallcytology should be obtained. DNA analysis may adduseful information in diagnosing mucinous cystswhen the previous studies are indeterminate. Newmolecular biomarkers are being investigated to improvediagnostic capabilities and management decisions inthese challenging cystic lesions. Current guidelinesrecommend surgical pancreatic resection as thestandard of care for symptomatic cysts and those withhigh-risk features associated with malignancy. EUSguidedcyst ablation is a promising minimally invasive,relatively low-risk alternative to both surgery andsurveillance.