title: Requirement of a single high-risk feature as an indication for EUS for the diagnosis of asymptomatic pancreatic cysts.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS) is widely used to evaluate pancreatic cysts. Recent American Gastroenterological Association (AGA) guideline limits EUS for evaluation of cysts with at-least two high-risk features (size ≥ 3 cm, dilated main pancreatic duct or presence of a solid component). We have investigated the impact of this guideline on sensitivity of EUS for pancreatic cancer and the reduction of EUS procedures for pancreas cysts.
  
  
  METHODS
  EUS procedures performed between 2004 and 2015 and related patient records were retrospectively reviewed to determine the presence or absence of high-risk features, and for the results of fine needle aspiration cytology.
  
  
  RESULTS
  Two hundred ten patients (108 males) underwent EUS for diagnostic evaluation of pancreatic cysts. Four patients (1.9%), all with at-least one high-risk feature, were diagnosed with cytologically-proven pancreatic cancer. Only 2 patients with cancer had at-least two high-risk features that would have warranted EUS examination based on the new AGA guideline. The requirement for at-least two high-risk features would have decreased the number of EUS procedures by 91%, but reduced the sensitivity for pancreatic malignancy to 50%. If only one high-risk feature was required, EUS procedures would have been decreased by 67%, with a sensitivity of 100%.
  
  
  CONCLUSIONS
  Limiting EUS to patients with pancreatic cysts with 2 or more high-risk features may substantially reduce the sensitivity for pancreatic malignancy. Performing EUS in patients with at least one high-risk feature may substantially decrease the need of invasive procedures without reducing sensitivity for detecting malignancy.
authors: Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: Divyanshoo.kohli@vcuhealth.org.
authors: Divyanshoo R
authors: DR
authors: Kohli
authors: Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA.
authors: Ashwani
authors: A
authors: Kapoor
authors: Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA.
authors: Doumit
authors: D
authors: BouHaidar
authors: Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA.
authors: Ravi
authors: R
authors: Vachhani
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity
keywords: Endoscopic ultrasound; Pancreas cancer; Pancreas cysts