Impact of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration on the management of pancreatic cystic lesions.
OBJECTIVE
Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are well-recognized techniques for the study of pancreatic cystic lesions (PCLs). However, little evidence exists on their impact on clinical care. The aim of this study is to determine how often EUS and EUS-FNA alter the diagnosis and management of patients with PCLs.


METHODS
Eight physicians expert in pancreatic diseases were asked to report their diagnoses and management recommendations for 49 different PCLs. Clinical information was sequentially disclosed in a stepwise manner - progressively from clinical data plus computed tomography or MRI (level 1), to EUS (level 2) and EUS-FNA results including cytology, carcinoembryonic antigen, and amylase levels (level 3).


RESULTS
EUS led to a change in the diagnosis and management in 30% [95% confidence interval (CI): 26-35%] and 19% (95% CI: 16-23%) of cases, respectively, usually to a more intensive approach (14%; 95% CI: 11-18%). EUS-FNA altered the diagnosis and management in an additional 39% (95% CI: 34-44%) and 21% (95% CI: 17-25%) of the evaluations, respectively. EUS-FNA also increased the consensus in the diagnosis among the specialists that ranged from fair with computed tomography/MRI (κ-index=0.32) to substantial with EUS-FNA (κ-index=0.43).


CONCLUSIONS
EUS and EUS-FNA impact the diagnosis and management of patients with PCLs; therefore, both are necessary in the workup of these patients. EUS-FNA markedly improves the agreement between physicians in terms of diagnosis, but not management. This study highlights the need for more research and standardization in the field.
aEndoscopy Unit, Hospital Clínic, IDIBAPS, CIBERehd Departments of bDigestive Surgery cGastroenterology, Hospital Clínic dDepartment of Gastroenterology, Hospital Vall d'Hebron, Barcelona eDepartment of Gastroenterology, Hospital de Terrassa, Terrassa fDepartment of Digestive Surgery, Hospital de Bellvitge, Hospitalet de Llobregat, Spain.
Antonio
A
Rodríguez-D'Jesús
Glòria
G
Fernández-Esparrach
Jaume
J
Boadas
Juli
J
Busquets
Laureano
L
Fernández-Cruz
Joana
J
Ferrer
Eva C
EC
Vaquero
Xavier
X
Molero
Salvador
S
Navarro
Santiago
S
Sánchez-Cabús
Isis K
IK
Araujo
Oriol
O
Sendino
Henry
H
Córdova
Cristina
C
Sánchez-Montes
Angels
A
Ginès
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results
D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D000681:Amylases