title: Pancreatic cyst epithelial denudation: a natural phenomenon in the absence of treatment.
abstract: OBJECTIVE
  The presence and significance of epithelial denudation among treatment-naïve pancreatic cystic lesions (PCLs) remain undetermined. The aims of this study were to determine the prevalence, extent, and predictors of epithelial denudation in treatment-naïve PCLs.
  
  
  METHODS
  Single-center retrospective study including patients who underwent EUS preceded by cross-sectional imaging and who subsequently underwent surgical resection of treatment-naïve PCLs. Surgically resected PCLs were reviewed by a pathologist in a fashion that allowed evaluation from evenly distributed regions of the cyst.
  
  
  RESULTS
  A total of 140 patients were identified (60% female, mean age 63 years). Eighty-five cysts (60.7%) were classified as intraductal papillary mucinous neoplasms (IPMNs), 33 (23.5%) as main duct IPMNs (m-IPMNs), 11 (7.9%) as serous cystadenomas (SCAs), and 11 (7.9%) were composed of other cyst subtypes. A greater extent of epithelial denudation was seen in mucinous cystic neoplasm (MCN) compared with IPMN and SCA (mean percentage of denuded epithelium 45.1%, 10.8%, and 22.4%, respectively [P < .0001]). An association existed between the extent of denuded epithelium and degree of cyst epithelial dysplasia for IPMN and MCN combined (mean percentage of denuded epithelium for low-, moderate-, and high-grade dysplasia being 23.3%, 4.5%, and 1.2%, respectively; P = .02). PCLs resected from the neck and/or body and/or tail of the pancreas were associated with a greater extent of mean percentage of denuded epithelium than PCLs resected from the head and/or uncinate of the pancreas (23.9% vs 13.4%; P = .035).
  
  
  CONCLUSIONS
  The presence and extent of cyst epithelial denudation of treatment-naïve PCLs vary with cyst histology and other factors. The observation of denudation after intracystic ablative therapy may not provide an adequate metric of successful intervention. Further studies are needed to validate these findings.
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA; Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gómez
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Shounak
authors.initials: S
authors.lastname: Majumder
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ferga C
authors.initials: FC
authors.lastname: Gleeson
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Barham K
authors.initials: BK
authors.lastname: Abu Dayyeh
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Randall K
authors.initials: RK
authors.lastname: Pearson
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Santhi S
authors.initials: SS
authors.lastname: Vege
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004848:Epithelium / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology*; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult