title: Endoscopic ultrasound identifies synchronous pancreas cystic lesions not seen on initial cross-sectional imaging.
abstract: OBJECTIVE
  A retrospective review conducted to determine the utility of endoscopic ultrasound (EUS) examination of the pancreas after initial pancreatic cyst detection with cross-sectional imaging.
  
  
  METHODS
  A retrospective review of 145 patients referred for EUS for evaluation of pancreas cystic lesions. Initial cross-sectional imaging reports were reviewed and compared to subsequent EUS findings. Findings evaluated included cyst size, number, multifocality, presence in different surgical fields, cyst wall nodularity, main pancreatic duct (PD) dilation, communication with PD, and features suggestive of serous cystadenoma.
  
  
  RESULTS
  Compared to computed tomographic scan, EUS more frequently identified pancreatic cystic lesion multifocality (47% vs 13%, P < 0.0001) and their presence in different surgical fields (33.3% vs 4.2%, P < 0.0001). Compared to magnetic resonance imaging, EUS was superior in identifying multifocality (58% vs 34%, P = 0.0002) and the presence of cysts in different surgical fields (42% vs. 26%, P = 0.021). Malignancy was suspected or confirmed in 3 patients by EUS fine-needle aspiration cytology, not suspected by cross-sectional imaging. Endoscopic ultrasound identified unappreciated features of serous cystadenomas in 10 patients.
  
  
  CONCLUSIONS
  Endoscopic ultrasound identified synchronous pancreatic cystic lesions unappreciated by initial cross-sectional imaging, with undetected cysts frequently outside of typical resection margins. In addition, EUS identified the presence of unappreciated high- or low-risk characteristics in a small percentage of patients.
authors.affiliation: Digestive Diseases Section, Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Adimoolam
authors.forename: Mayra J
authors.initials: MJ
authors.lastname: Sanchez
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.forename: James D
authors.initials: JD
authors.lastname: Dzuira
authors.forename: Manmeet S
authors.initials: MS
authors.lastname: Padda
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D003237:Connecticut; D018293:Cystadenoma, Serous / Q000000981:diagnostic imaging* / Q000473:pathology; D004108:Dilatation, Pathologic; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed