title: Impact of endoscopic ultrasound-guided fine-needle aspiration on incidental pancreatic cysts. A prospective study.
abstract: OBJECTIVE
  Widespread use of imaging procedures has promoted a higher identification of incidental pancreatic cysts (IPCs). However, little is known as to whether endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could change the management strategy of patients having IPCs. This study has aimed to evaluate the management impact of EUS-FNA on IPCs.
  
  
  METHODS
  Patients with pancreatic cysts (PCs) who were referred to EUS-FNA were recruited prospectively. The referring physicians were questioned about the management strategy for these patients before and after EUS-FNA. The impact of EUS-FNA on management was then evaluated.
  
  
  RESULTS
  A total of 302 PC patients were recruited. Of these, 159 (52.6%) patients had asymptomatic IPCs. The average size was 2.3 cm (range: 0.2-7.1 cm), and 110 patients having smaller than 3 cm sized cysts. Lesions were located in the pancreatic head in 96 (61%) cases, and most patients (94%) had only a single cyst. The final diagnoses, obtained by EUS-FNA (91) and surgery (68), were 93 (58%) benign lesions, 36 (23%) cysts with malignant potential, 14 (9%) noninvasive malignancies, 10 (6%) malignant precursor lesions (PanIN), and 6 (4%) invasive malignancies. Management strategy changed significantly after EUS-FNA in 114 (71.7%) patients: 43% of the cases were referred to surgery, 44% of the patients were discharged from surveillance, and 13% of the cases were given further periodical imaging tests.
  
  
  CONCLUSIONS
  EUS-FNA has a management impact in almost 72% of IPCs, with a major influence on the management strategy, either discharge rather than surgical resection or surgery rather than additional follow up.
authors.affiliation: Division of Surgery and Anatomy, Ribeirão Preto Medical School - University of São Paulo , São Paulo , Brazil.
authors.forename: José Celso
authors.initials: JC
authors.lastname: Ardengh
authors.forename: César Vivian
authors.initials: CV
authors.lastname: Lopes
authors.forename: Eder Rios
authors.initials: ER
authors.lastname: de Lima-Filho
authors.forename: Rafael
authors.initials: R
authors.lastname: Kemp
authors.forename: José Sebastião
authors.initials: JS
authors.lastname: Dos Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003537:Cystadenoma / Q000473:pathology* / Q000601:surgery; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010181:Pancreatic Cyst / Q000473:pathology* / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D057832:Watchful Waiting; D055815:Young Adult