title: Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions.
abstract: The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making.
  
  
  
  Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection.
  
  
  
  A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration.
  
  
  
  In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N924 Doan Hall, Columbus, OH, 43210, USA. lawrence.shirley@osumc.edu.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Shirley
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Walker
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Somashekar
authors.initials: S
authors.lastname: Krishna
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: El-Dika
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N924 Doan Hall, Columbus, OH, 43210, USA.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
authors.affiliation: Division of Surgical Oncology, 21st Century Oncology, Ft. Myers, FL, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D000066491:Clinical Decision-Making; D020420:Cyst Fluid / Q000166:cytology* / Q000378:metabolism; D003581:Cytodiagnosis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D010179:Pancreas / Q000473:pathology; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002272:Carcinoembryonic Antigen; D009077:Mucins; D000681:Amylases
keywords: Amylases; Carcinoembryonic antigen; Cytology; Pancreatic cysts; Pancreatic neoplasms