[Diagnostic value of cyst fluid analysis in cystic lesions of the pancreas: current data, limitations, and perspectives].
Diagnostic assessment and therapeutic indications in patients with cystic lesions of the pancreas are often difficult, especially since incidental detection of such lesions is increasing due to improvements in imaging techniques. Some lesions are benign (pseudocyst, serous cystadenoma) requiring conservative management and follow-up, whereas others are premalignant (mucinous cystadenoma, intraductal papillary mucinous tumor.) or frankly malignant (cystadenocarcinoma) and require surgical resection when possible. In about a third of cases, imaging findings are not sufficiently accurate in establishing the diagnosis, especially in cases of unilocular lesions. Fine needle aspiration can be considered as a second line method in uncertain cases. Aspiration should be performed in specialized services as the procedure requires careful consideration in some patients. Complications are usually rare and minor. The most accurate markers in this field are the carcinoembryonic antigen and the Ca 72.4. They allow to distinguish between a pseudocyst or a serous cystadenoma and a mucinous tumor (benign or malignant) with a 60% sensitivity and a specificity of nearly 100%. Cytological or histological analysis can provide valuable information but their accuracy seems to depend on tumor type. Genetic studies (Ki-ras.) may be possible in the future, including lesions with low cellular cyst fluid content. In conclusion, cyst fluid analysis after fine needle aspiration is a useful diagnostic tool but should always be interpreted in combination with clinical data and imaging findings.
Hammel
P
P
Fédération Médico-Chirurgicale d'Hépato-Gastroentérologie, Hôpital Beaujon, 100 boulevard Leclerc, 92110 Clichy. pascal.hammel@bjn.ap-hop-paris.fr
D020420:Cyst Fluid / Q000737:chemistry*; D006801:Humans; D010181:Pancreatic Cyst / Q000175:diagnosis*; D011677:Punctures / Q000009:adverse effects / Q000379:methods