title: Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms.
abstract: OBJECTIVE
  To evaluate the performance characteristics of endoscopic ultrasonography (EUS) compared with computed tomography (CT) and magnetic resonance imaging (MRI) and determine the incremental diagnostic yield and accuracy of EUS with or without fine needle aspiration (FNA) over CT and MRI for prediction of neoplastic pancreatic cysts.
  
  
  METHODS
  The EUS database was queried for procedures performed for pancreatic cysts between March 2006 and January 2010. Cystic pancreatic ductal adenocarcinoma, cystic pancreatic neuroendocrine tumor, mucinous cystic neoplasm, intraductal papillary neoplasm, and solid pseudopapillary neoplasm were categorized as neoplastic; pseudocysts and serous cysts were designated as nonneoplastic/low risk.
  
  
  RESULTS
  Final diagnoses were established by surgery in 154 patients (mucinous cystic neoplasm/intraductal papillary neoplasm [69.4%], pancreatic neuroendocrine tumor [10%], pancreatic ductal adenocarcinoma [6.4%], solid pseudopapillary neoplasm [0.6%], nonneoplastic/low risk [13.6%]). Endoscopic ultrasonography with or without FNA was superior to CT and MRI in accurately classifying a cyst as neoplastic (P < 0.0001). After CT and MRI, EUS increased the rate of correctly predicting neoplastic cysts in 43 (36%) and 27 (54%) additional cases, respectively.
  
  
  CONCLUSIONS
  The incremental increase in diagnostic yield of EUS and fluid analysis over CT and MRI for prediction of a neoplastic cyst is 36% and 54%, respectively. The addition of EUS-FNA to abdominal imaging significantly increases overall accuracy for diagnosis of neoplastic pancreatic cysts.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Katherine
authors.initials: K
authors.lastname: Kim
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: April S
authors.initials: AS
authors.lastname: Tignor
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed