title: Predictors of malignancy in patients with suspicious or indeterminate cytology on pancreatic endoscopic ultrasound-guided fine-needle aspiration: a multivariate model.
abstract: OBJECTIVE
  The aim of this study was to evaluate predictors of malignancy in pancreatic lesions with suspicious or indeterminate endoscopic ultrasound fine-needle aspiration (EUS-FNA) cytology.
  
  
  METHODS
  Suspicious/indeterminate EUS-FNA cytology was identified from our database. Stable imaging, benign pathology, or survival for 12 months after EUS-FNA was considered benign. Diagnosis of malignancy was based on positive pathology, local invasion/metastasis on imaging, or death within 12 months from cancer-associated causes. Univariate analysis was performed to compare variables between benign and malignant lesions. Multivariate analysis (covariates: age [<70 or ≥70], appearance [solid/cystic], size [<20 or ≥20 mm], and serum CA19-9 [<40 or ≥40]) was performed using binary logistic regression.
  
  
  RESULTS
  There were 81 patients with suspicious or indeterminate cytology. Final diagnosis was cancer in 55 (67.9%) of 81 (adenocarcinoma in 40/81 [49.4%], "other neoplasms" in 15/81 [18.5%]) and benign in 26 (32.1%) of 81. Univariate analysis revealed a difference in age, lesion size, solid/cystic characteristics, and serum CA 19-9 between benign and malignant lesions. Only elevated serum CA 19-9 was independently associated with a diagnosis of malignancy on multivariate analysis.
  
  
  CONCLUSIONS
  Age, lesion size, and solid/cystic characteristics on EUS were not independently associated with cancer. Pancreatic lesions with suspicious/indeterminate cytology and elevated serum CA 19-9 should be considered as concerning for a malignant diagnosis.
authors: From the Division of Gastroenterology, University of Florida, Gainesville, FL.
authors: Dennis
authors: D
authors: Yang
authors: Koorosh
authors: K
authors: MoezArdalan
authors: Dennis P
authors: DP
authors: Collins
authors: Shailendra S
authors: SS
authors: Chauhan
authors: Peter V
authors: PV
authors: Draganov
authors: Chris E
authors: CE
authors: Forsmark
authors: Mihir S
authors: MS
authors: Wagh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000473:pathology*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D018395:CA-19-9 Antigen