Fine needle aspiration of pancreatic cysts: Use of ancillary studies and difficulty in identifying surgical candidates.
OBJECTIVE
To evaluate ancillary biochemical testing after pancreatic cyst fine needle aspiration (FNA) in the clinical setting.


METHODS
Findings from 110 pancreatic guided FNA were reviewed cysts evaluated by image- and correlated with histology, clinical follow-up and biochemical analysis of cyst fluid and serum. Adequate followup was available for 95.


RESULTS
In terms of identifying cysts requiring surgery, FNA showed 55.3% sensitivity, 95% specificity, 92.9% positive predictive value (PPV) and 64.4% negative predictive value (NPV). FNA showed only nonspecific cyst contents in 51% of cases, but 40% of those patients proved to be surgical candidates at follow-up. Overall, patients with lesions requiring surgery were younger (p = 0.14), more often presented with pain (p = 0.006), had larger cysts (p = 0.05) and less often had a history of chronic pancreatitis (p = 0.12). Among cases in which FNA showed only nonspecific cyst contents, patients with lesions requiring surgery were more often female (p = 0.08), were younger (p = 0.10), had larger cysts (p = 0.06) and had pain at presentation (p = 0.02). Differences in fluid and serum analytes were not statistically significant.


CONCLUSIONS
FNA of pancreatic cysts shows high specificity but poor sensitivity, even with cyst fluid and serum biochemical analysis. FNA of cysts requiring surgery often yielded nonspecific cyst cytology and causing a misinterpretation as pseudocysts. Ancillary biochemical analysis of cyst fluid remains problematic in the clinical setting.
Volmar
Keith E
KE
Department of Pathology, University of North Carolina Chapel Hill, North Carolina 27599, USA. kevolmar@yahoo.com
Creager
Andrew J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010181:Pancreatic Cyst / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D010340:Pathology, Surgical / Q000379:methods*; D012680:Sensitivity and Specificity