Safety and diagnostic performance of endoscopic ultrasound-guided fine needle biopsy in pancreatic cystic and mixed lesions

Table 1 Patient and lesion characteristics in imaging, n (%)/mean ± SD

Variable	Total patients (n = 60)
Sex (female)	22 (36.6)
Mean age at time of procedure (years)	65.0 ± 12.1
History of diabetes mellitus	20 (33.3)
Symptoms
Abdominal pain	30 (50.0)
Jaundice	6 (10.0)
Asymptomatic (accidentally discovered)	20 (33.3)
Ascites	1 (1.7)
Weight loss	3 (5.0)
Initial imaging modality
CT	24 (40.0)
MRCP	34 (56.7)
Missing data	2 (3.3)
Mean lesion diameter (mm)	36.2 ± 29.3
Location
Head	23 (38.3)
Body	13 (21.7)
Tail	13 (21.7)
Isthmus	7 (11.7)
Uncinate	2 (3.3)
Missing data	2 (3.3)
Pancreatic duct dilatation > 5 mm	19 (31.7)
Mural nodule	3 (5.0)
Diagnostic assumption
Cystic lesion	17 (28.4)
Mixed lesion	36 (60.0)
Nodule (solid lesion)	5 (8.3)
Missing data	2 (3.3)

CT: Computed tomography; MRCP: Magnetic resonance cholangiopancreatography.

Table 2 Lesion characteristics in endoscopic ultrasound and endoscopic ultrasound-guided fine needle biopsy results, n (%)/mean ± SD/median (interquartile range)

Variable	Value
Mean lesion diameter (mm)	32.4 ± 16.6
Location
Head	24 (40.0)
Body	15 (25.0)
Tail	11 (18.3)
Isthmus	9 (15.0)
Uncinate	1 (1.7)
EUS aspect
Unilocular	23 (38.3)
Multilocular	24 (40.0)
Microcystic	13 (21.7)
Mural nodule	7 (11.7)
Wall
Thin	40 (66.7)
Thick	15 (25.0)
Undefined	5 (8.3)
Content
Clear	17 (28.3)
Turbid	4 (6.7)
Non contributive	39 (65)
Calcifications	7 (11.7)
Presence of solid component	41 (68.3)
Lesion type
Mixed cyst	41 (68.3)
Cystic	19 (31.7)
Pancreatic duct dilatation (5-9.9 mm)	19 (31.7)
Pancreatic duct dilatation (≥ 10 mm)	2 (3.3)
Mean dilatation (mm)	2.5 ± 3.6
Communication with pancreatic duct	5 (8.3)
Number of needle passes
1	12 (20.0)
2	39 (65.0)
3	9 (15.0)
Mean number of needle passes	1.9 ± 0.6
Lymph nodes	12 (20.0)
Complications	0 (0.0)
Adequate cells, tissue or fluid for analysis	57 (95.0)
Prophylactic antibiotic	47 (78.3)
Pathological diagnosis
Diagnostic pathology	51 (85)
Pancreatic adenocarcinoma	13 (21.7)
Well differentiated	24 (40.0)
Moderately differentiated	6 (10.0)
Poor differentiated	5 (8.3)
Serous cystadenoma	6 (10.0)
IPMN	6 (10.0)
LGD	2 (3.3)
HGD	4 (6.7)
Mucinous cystadenoma	3 (5.0)
Neuroendocrine tumor	3 (5.0)
Pseudo papillary tumor	1 (1.7)
Pseudocyst	2 (3.3)
Chronic pancreatitis	2 (3.3)
Duplication duodenal cyst	1 (1.7)
Epidermoid carcinoma	1 (1.7)
Fibrosis	1 (1.7)
Normal	1 (1.7)
Non diagnostic pathology	9 (15.0)
Follow-up diagnosis (n = 9)
Pancreatic adenocarcinoma	2 (22.2)
Serous cystadenoma	3 (33.3)
IPMN	1 (11.1)
Granuloma	1 (11.1)
Indeterminate cyst	2 (22.2)
Cyst fluid biochemical analysis
CEA, n = 12	33.4 (4.7-6059.0)
CA19-9, n = 12	1087 (77.9-116082.0)
Glucose, n = 15	1.6 (0.35-4.3)
Lipase, n = 14	628 (126.3-36972.8)
Amylase, n = 3	227 (154.0-19448)

CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; EUS: Endoscopic ultrasound; HGD: High grade dysplasia; IPMN: Intraductal papillary mucinous neoplasm; LGD: Low grade dysplasia.

Table 3 Comparison of clinical, imaging and endoscopic ultrasound characteristics between pancreatic cystic lesions and mixed pancreatic cystic lesions, n (%)/mean ± SD

Variable	PCLs (n = 19)	mPCLs (n = 41)	P value
Sex (female)	13 (68.4)	22 (53.7)	0.425
Mean age at time of procedure (years)	61.8 ± 13.4	66.9 ± 11.2	0.167
History of diabetes mellitus	3 (15.8)	17 (41.5)	0.077
Symptoms
Abdominal pain	12 (63.2)	18 (43.9)	0.267
Jaundice	0 (0.0)	6 (14.6)	0.163
Asymptomatic (accidentally discovered)	7 (36.8)	13 (31.7)	0.922
Ascites	0 (0.0)	1 (2.4)	1.000
Weight loss	0 (0.0)	3 (7.3)	0.545
Initial imaging modality
CT	6 (31.6)	18 (43.9)	0.350
MRCP	13 (68.4)	21 (51.2)
Missing data	0 (0.0)	2 (4.9)
Mean lesion diameter on initial imaging (mm)	24.3 ± 8.3	37.1 ± 17.4	0.002
Location on initial imaging
Head/isthmus/uncinate	11 (57.9)	21 (51.2)	0.838
Body	2 (10.5)	11 (26.8)	0.194
Tail	6 (31.6)	7 (17.1)	0.351
Missing data	0 (0.0)	2 (4.9)	1.000
Pancreatic duct dilatation > 5 mm	5 (26.3)	14 (34.1)	0.666
Mural nodule on initial imaging	3 (15.8)	0 (0.0)	0.055
Diagnostic assumption			< 0.0001
Cystic lesion	15 (78.9)	2 (4.9)
Mixed or solid lesion	4 (21.1)	37 (90.2)
Missing	0 (0.0)	2 (4.9)
Mean large lesion diameter on EUS (mm)	24.3 ± 8.3	37.1 ± 17.4	0.002
Location on EUS
Head/isthmus/uncinate	12 (63.2)	22 (53.7)	0.681
Body	2 (10.5)	13 (31.7)	0.112
Tail	5 (26.3)	6 (14.6)	0.466
Mural nodule	4 (21.1)	3 (7.3)	0.193
Pancreatic duct dilatation (≥ 5 mm)	5 (26.3)	16 (39.0)	0.624
Mean dilatation (mm)	2.2 ± 3.9	2.7 ± 3.5	0.608
Number of needle passages	1.7 ± 0.7	2.0 ± 0.5	0.056
Lymph nodes	2 (10.5)	10 (24.4)	0.306
Adequate cells, tissue or fluid for analysis	18 (94.7)	39 (95.1)	1.000
Prophylactic antibiotic	15 (78.9)	32 (78.0)	1.000

CT: Computed tomography; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography; PCLs: Pancreatic cystic lesions; mPCLs: Mixed pancreatic cystic lesions.

Table 4 Follow-Up and outcomes, n (%)/mean ± SD

Variable	Total patients (n = 60)
Mean follow-up duration (months) from date of procedure to date of death or last visit	17.0 ± 14.3
Management
Follow up	13 (21.7)
Repeat EUS and diagnosis	6 (10.0)
Chemotherapy	23 (38.3)
Surgical	10 (16.7)
Drainage	1 (1.7)
Missing data	7 (11.6)
Concordance of EUS-FNB compared to surgical pathology for patients who had surgery	10/10 (100)
Death	14 (23.3)
Cause of death
Metastatic pancreatic cancer	11/14 (78.6)
Other death	2/14 (14.3)
Other cancers	1/14 (7.1)

EUS: Endoscopic ultrasound; FNB: Fine needle biopsy.