The role of ancillary tests in the evaluation and management of patients with negative and non-diagnostic pancreatic cyst aspirates.

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.

CONCLUSION: 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.