Review of the Findings of Endosonography and Fine Needle Aspiration in Patients with Cystic Tumors of Pancreas in Two Hospitals

Improvements in imaging techniques has led to an increase in the number of diagnosed pancreatic cysts. Although most of the detected cases are benign, a significant percentage of them are malignant or are potentially malignant. Currently, endosonography, and analysis of cyst morphology, fine needle aspiration (FNA) of the cyst contents, and measurement of the amylase and carcinoembryonic antigen (CEA) levels of the aspirated fluid are the common methods used for evaluating such lesions (80% accuracy in the final diagnosis). We have used these same techniques to analyze cystic lesions of the pancreas, in two referring centers in Iran.
This is a descriptive case series study. In addition to demographic information and findings of the cystic morphology, we determined the cytology of the centrifuged sediments of cystic fluid aspirations, and the amylase and CEA levels of the fluid.
Sixty eight patients were included in the study with an average age of 51 years. 68% of the participants were female (n=46). Analysis of the lesions was performed based on the cytology findings as well as the other results (CEA, amylase, cyst morphology, and history of pancreatitis). The patients who were diagnosed as having pseudocysts were the youngest group, with an average age of 41 years, and those with cystic adenocarcinoma were the oldest group, with an average age of 62 years. The most common types of lesions were pseudocysts (n=18, 26.5%), mucinous cystic neoplasms (n=11, 16%), serous cyst adenomas (n=10, 14.7%), intraductal papillary mucinous neoplasms (n=9, 13.2%), and cystic adenocarcinoma (n=9, 13.2%). The most common location of cysts was the head of pancreas (n=25, 35.2%). Excluding the neuroendocrine tumors, all other types of lesions were more common in women than men. Septation in the cysts was observed in cystic adenocarcinomas, serous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs). Lesions smaller than 2 cm were found most frequently in IPMNs, endocrine tumors, and simple tumors whilst pseudocysts were all greater than 2 cm in maximum diameter.
47% of the patients in this study had malignant or premalignant lesions, which despite being asymptomatic, they needed follow-up imaging or surgery. Endosonography played an important role in the diagnosis of the cystic tumors of the pancreas. Diagnosis of premalignant lesions and providing appropriate treatment increase patients’ life expectancy. Diagnosis of benign cysts, leads to fewer unnecessary surgeries.