Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2015; 7(4): 318-327
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.318
Endoscopic ultrasound in the evaluation of pancreatic neoplasms-solid and cystic: A review
Eric M Nelsen, Darya Buehler, Anurag V Soni, Deepak V Gopal
Eric M Nelsen, Anurag V Soni, Deepak V Gopal, Division of Gastroenterology and Hepatology, University of Wisconsin - School of Medicine and Public Health, Madison, WI 53705, United States
Darya Buehler, Department of Pathology and Laboratory Medicine, University of Wisconsin - School of Medicine and Public Health, Madison, WI 53705, United States
Author contributions: Nelsen EM contributed to drafting of manuscript, review of literature and review of final manuscript; Buehler D contributed to drafting of manuscript, preparation and review of pathology; Soni AV contributed to drafting of manuscript and review of final manuscript; Gopal DV contributed to coordinator of manuscript, drafting of manuscript and approval of final manuscript.
Conflict-of-interest: Authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Deepak V Gopal, MD, FRCP(C), AGAF, FACG, FASGE, Professor of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin - School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, United States. dvg@medicine.wisc.edu
Telephone: +1-608-2637322
Received: September 13, 2014
Peer-review started: September 13, 2014
First decision: September 28, 2014
Revised: October 31, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 16, 2015
Processing time: 218 Days and 13.5 Hours
Abstract

Pancreatic neoplasms have a wide range of pathology, from pancreatic adenocarcinoma to cystic mucinous neoplasms. Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) is a helpful diagnostic tool in the work-up of pancreatic neoplasms. Its utility in pancreatic malignancy is well known. Over the last two decades EUS-FNA has become a procedure of choice for diagnosis of pancreatic adenocarcinoma. EUS-FNA is highly sensitive and specific for solid lesions, with sensitivities as high as 80%-95% for pancreatic masses and specificity as high as 75%-100%. Multiple aspects of the procedure have been studied to optimize the rate of diagnosis with EUS-FNA including cytopathologist involvement, needle size, suctioning and experience of endoscopist. Onsite pathology is one of the most important elements in increasing diagnostic yield rate in EUS-FNA. EUS-FNA is valuable in diagnosing rare and atypical pancreatic neoplasms including neuroendocrine, lymphoma and metastatic disease. As more and more patients undergo cross sectional imaging, cystic lesions of the pancreas are becoming a more common occurrence and EUS-FNA of these lesions can be helpful for differentiation. This review covers the technical aspects of optimizing pancreatic neoplasm diagnosis rate, highlight rare pancreatic neoplasms and role of EUS-FNA, and also outline the important factors in diagnosis of cystic lesions by EUS-FNA.

Keywords: Endoscopic ultrasound-fine needle aspiration; Pancreatic neoplasms; Pancreatic cysts; Review; Pancreatic adenocarcinoma

Core tip: Endoscopic ultrasound-fine needle aspiration (EUS-FNA) is a common, reliable way of obtaining tissue from within the abdominal cavity. This review details the current evidence of optimizing EUS-FNA results for pancreatic lesions, specifically adenocarcinoma. EUS and cytology from rare pancreatic lesions are highlighted to demonstrate the wide variety of pancreatic lesions and the importance of cytopathology. Also covered are cystic lesions and the ability of EUS-FNA to differentiate cysts based on EUS appearance and aspiration analysis including new DNA analysis and measurement of k-ras mutation.