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Endoscopic Ultrasonography: Role of EUS sampling in Cystic Lesions

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Pancreatic Masses

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Abstract

Pancreatic cystic lesions (PCLs) have been detected more frequently as a result of the increasing use of high-resolution cross-sectional imaging and the growth of the aging population in recent years. Among the common types of PCLs, the mucinous cystic neoplasms and the intraductal papillary mucinous neoplasms are well known with their malignant potential. Therefore, their differentiation from nonmucinous cysts is very important to help guide further management and prevention of invasive cancers. Cross-sectional imaging is very helpful for screening and detection of PCLs, but their value to differentiate types of cysts is limited. Endoscopic ultrasound (EUS) allows for high-frequency imaging of the pancreas and provides morphologic characteristics of cystic lesions. However, its capability to differentiate benign and malignant cysts or mucinous and nonmucinous lesions is still limited. Besides, it is an operator-dependent technique and interobserver agreement is not high. EUS-guided fine-needle aspiration (FNA) provides cyst fluid for further analysis and improves significantly the differentiation of benign/malignant and mucinous/nonmucinous PCLs. Gross appearance of fluid, cytological examination, fluid amylase, and CEA levels are helpful in certain lesions for differential diagnosis. Molecular analysis of KRAS and GNAS mutations have been proposed in recent years to further improve the mucinous/nonmucinous discrimination. New tests and methods are still under investigation to improve the diagnostic yield of EUS-FNA. In this chapter, the key issues of EUS-FNA in the differential diagnosis of PCLs are reviewed based on the recent literature.

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Authors and Affiliations

  1. Medicine and Gastrointestinal Unit, Pancreas Biliary Center, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA, 02114, USA

    Abdurrahman Kadayifci M.D. & William R. Brugge M.D.

  2. Division of Gastroenterology, University of Gaziantep, Gaziantep, Turkey

    Abdurrahman Kadayifci M.D.

Authors
  1. Abdurrahman Kadayifci M.D.
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  2. William R. Brugge M.D.
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Correspondence to William R. Brugge M.D. .

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Editors and Affiliations

  1. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Mihir S. Wagh

  2. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Peter V. Draganov

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© 2016 Springer International Publishing Switzerland

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Kadayifci, A., Brugge, W.R. (2016). Endoscopic Ultrasonography: Role of EUS sampling in Cystic Lesions. In: Wagh, M., Draganov, P. (eds) Pancreatic Masses. Springer, Cham. https://doi.org/10.1007/978-3-319-19677-0_11

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  • DOI: https://doi.org/10.1007/978-3-319-19677-0_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19676-3

  • Online ISBN: 978-3-319-19677-0

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