title: Sonographic and cyst fluid cytologic changes after EUS-guided pancreatic cyst ablation.
abstract: OBJECTIVE
  The effect of EUS-guided pancreatic cyst ablation (PCA) on sonographic morphology and cyst fluid cytology is unknown. The aim of this study was to evaluate morphologic, cytologic, and change in cyst fluid DNA after PCA.
  
  
  METHODS
  In a prospective single-center study, consecutive patients with suspected benign 10- to 50-mm pancreatic cysts underwent baseline EUS-FNA and EUS-PCA followed 2 to 3 months later by repeat EUS, cyst fluid analysis, and possible repeat PCA. Surveillance imaging after ablation was performed at least annually and classified as complete response (CR), partial response, or persistent, with <5%, 5% to 25%, and 25% of the original cyst volume, respectively.
  
  
  RESULTS
  Thirty-six patients underwent EUS-PCA with ethanol alone (n = 8) or ethanol and paclitaxel (n = 28), and CR occurred in 19 patients (56%). After EUS-PCA, EUS showed an increase in wall diameter in 68%, decreased number of septations in 24%, increased debris in 24%, loss of mural nodule or novel calcification in 21%, and alteration of fluid viscosity in 48%. Follow-up cytology showed increased epithelial cellularity in 27%, loss or decreased cellular atypia in 15%, increased or appearance of macrophages in 24%, and inflammatory cells in 15%. Postablation DNA amount increased and quality decreased in 71% each. Between the CR and non-CR patients, there was no significant difference in frequency of sonographic or cytologic features. In the CR group, mean DNA quantity was significantly increased after ablation (P = .023) without a change in quality (P = .136).
  
  
  CONCLUSIONS
  EUS-PCA induces morphologic and cytologic changes of pancreatic cysts, none of which appears to predict overall imaging-defined response to ablation. (Clinical trial registration numbers: NCT00233038 and NCT01643460.).
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Kook Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McGreevy
authors.affiliation: Department of Cytopathology and Laboratory Medicine, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: La Fortune
authors.affiliation: Department of Cytopathology and Laboratory Medicine, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Cramer
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA.
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020420:Cyst Fluid / Q000737:chemistry / Q000166:cytology*; D004247:DNA / Q000032:analysis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008264:Macrophages; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D012997:Solvents / Q000627:therapeutic use*; D050257:Tubulin Modulators / Q000627:therapeutic use*; D014463:Ultrasonography; D014783:Viscosity
chemical_list: D012997:Solvents; D050257:Tubulin Modulators; D000431:Ethanol; D004247:DNA; D017239:Paclitaxel