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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2016; 8(2): 159-164
Published online Feb 15, 2016. doi: 10.4251/wjgo.v8.i2.159
Endoscopic approach to the diagnosis of pancreatic cystic tumor
Yoshiaki Kawaguchi, Tetsuya Mine
Yoshiaki Kawaguchi, Tetsuya Mine, Department of Gastroenterology, Tokai University School of Medicine, Isehara 259-1193, Japan
Author contributions: Kawaguchi Y contributed mainly to this work; Kawaguchi Y wrote the paper; Mine T supported and checked the paper.
Conflict-of-interest statement: This manuscript has not been published or presented elsewhere in part or in entirety, and is not under consideration by another journal. All the authors have approved the manuscript and agree with submission to your esteemed journal. There are no conflicts of interest to declare.
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: Yoshiaki Kawaguchi, MD, PhD, Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan. y711kawa@is.icc.u-tokai.ac.jp
Telephone: +81-463-931121 Fax: +81-463-937134
Received: April 28, 2015
Peer-review started: May 4, 2015
First decision: September 8, 2015
Revised: October 3, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: February 15, 2016
Processing time: 280 Days and 18.5 Hours
Abstract

Because of the aging of the population, prevalence of medical checkups, and advances in imaging studies, the number of pancreatic cystic lesions detected has increased. Once these lesions are detected, neoplastic cysts should be differentiated from non-neoplastic cysts. Furthermore, because of the malignant potential of some neoplastic pancreatic cysts, further differentiation between benign and malignant cysts should be made regardless of their size. Although endoscopic ultrasound (EUS) has a very high diagnostic performance for pancreatic cystic lesions among the various imaging modalities, EUS findings alone are insufficient for the differentiation of pancreatic cysts and diagnosis of malignancy. In addition, cytology by EUS-guided fine-needle aspiration (FNA) has a high specificity but a low sensitivity for diagnosing malignancy in pancreatic cystic tumors. The levels of amylase, lipase, and tumor markers in pancreatic cystic fluid are considered auxiliary parameters for diagnosis of benign and malignant cysts, and a definitive diagnosis of malignancy using these parameters is difficult. Thus, in addition to EUS, cytology by EUS-FNA, and cystic fluid analysis, new techniques based on EUS-guided through-the-needle imaging, such as confocal laser endomicroscopy and cystoscopy, have been explored in recent years.

Keywords: Endoscopic ultrasound; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound-needle aspiration; Pancreatic cystic tumor; Cytology

Core tip: The number of pancreatic cystic lesions detected has increased. Neoplastic cysts should be differentiated from non-neoplastic cysts. Further differentiation between benign and malignant cysts should be made regardless of their size. In addition to endoscopic ultrasound (EUS), cytology by EUS-fine-needle aspiration, and cystic fluid analysis, new techniques based on EUS-guided through-the-needle imaging, such as confocal laser endomicroscopy and cystoscopy, have been explored in recent years. We reviewed an endoscopic approach to the diagnosis of pancreatic cystic tumor.