title: The role of ancillary tests in the evaluation and management of patients with negative and non-diagnostic pancreatic cyst aspirates.
abstract: BACKGROUND
  Fine needle aspiration of pancreatic cystic lesions has its limitations as the cytology is often paucicellular to acellular. This study reports on the value of ancillary tests, amylase and carcinoembryonic, in the evaluation and management of patients with negative and non-diagnostic pancreatic cysts.
  
  
  METHODS
  From January 1, 2010 through December 31, 2015, the Cytopathology Laboratory processed 119 pancreatic cyst aspirates of which 51(43%) were negative and 52(44%) were non-diagnostic and form the basis of this study. The 103 patients, 66 men and 37 women underwent endoscopic ultrasound with fine needle aspiration and biochemical and biomarker analysis; amylase and carcinoembryonic antigen, of cyst contents. In this study, the cytologic findings were interpreted independent of the cyst fluid analysis.
  
  
  RESULTS
  Of the 51 patients with negative pancreatic cyst aspirates, combined endoscopic ultrasound/cytology/cyst fluid analysis findings were compatible with 37 (72%) pseudocysts, 11 (22%) serous cystadenomas, and 3 (6%) intraductal papillary mucinous neoplasms. Of the 52 patients with non-diagnostic pancreatic cyst aspirates, combined endoscopic ultrasound/cyst fluid analysis findings were compatible with 17 (33%) pseudocysts, 17 (33%) serous cystadenomas, 14 (27%) intraductal papillary mucinous neoplasms, and 4 (7%) mucinous cystic neoplasms. Eight patients underwent surgical resection and the remaining 95 patients were managed medically with repeat imaging.
  
  
  CONCLUSIONS
  Ancillary tests are of added benefit in the evaluation and management of patients with negative and non-diagnostic pancreatic cyst aspirates. Diagn. Cytopathol. 2017;45:303-307. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Selvaggi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*
keywords: ancillary tests; carcinoembryonic antigen and amylase; fine needle aspiration cytology; pancreatic cysts