title: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) contributes to a triple-negative test in preoperative screening of pancreatic cysts.
abstract: BACKGROUND
  Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cysts obtains cyst fluid for cytologic and biochemical analysis, which may determine whether the cyst is mucinous and malignant, contributing to patient management. Despite this added value, EUS-FNA remains controversial in the preoperative assessment of pancreatic cysts. The objective of this study was to assess the utility of EUS-FNA in a cohort of small pancreatic cysts that were benign on imaging studies.
  
  
  METHODS
  All pancreatic cysts that underwent initial EUS-FNA in 2006 and 2007 were retrospectively analyzed. Ninety-two patients with pancreatic cysts met the inclusion criteria. Patients who had high-risk or worrisome features on imaging studies were excluded. Cytology, histology, and cyst fluid analysis data were collected. The main outcome measurements were radiologic and clinical follow-up as well as cytopathologic and histologic results.
  
  
  RESULTS
  EUS-FNA supported a diagnosis of a mucinous cyst in 38 of 92 patients (41%) by carcinoembryonic antigen (CEA) measurement and/or cytology. Cytology demonstrated an absence of high-grade atypia (HGA) in 89 of 92 patients (97%). The mean follow-up was 4.4 years (range, 0-7.7 years), during which 6 cysts were surgically resected and 16 cysts were resampled by at least 1 subsequent EUS-FNA. The overall negative predictive value of cytologic examination for HGA was 99%.
  
  
  CONCLUSIONS
  EUS-FNA is a screening test that contributes to a triple-negative test for pancreatic cysts--no high-risk stigmata, no worrisome features, and no HGA on cytology--providing a negative predictive value of 99% for conservative management.
authors: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Roseann I
authors: RI
authors: Wu
authors: Won Jae
authors: WJ
authors: Yoon
authors: William R
authors: WR
authors: Brugge
authors: Mari
authors: M
authors: Mino-Kenudson
authors: Martha B
authors: MB
authors: Pitman
mesh_terms: D002272:Carcinoembryonic Antigen / Q000032:analysis; D020420:Cyst Fluid / Q000737:chemistry / Q000000981:diagnostic imaging*; D018282:Cystadenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen
keywords: carcinoembryonic antigen; cytopathology; endoscopic ultrasound-guided fine-needle aspiration; pancreatic cyst; pancreatic neoplasms