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Endoscopic diagnosis of cystic lesions of the pancreas
Author(s) -
Kamata Ken,
Kitano Masayuki
Publication year - 2019
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13257
Subject(s) - medicine , endoscopic ultrasonography , intraductal papillary mucinous neoplasm , pancreas , radiology , differential diagnosis , endoscopy , diagnostic accuracy , cytology , pathology
Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography ( EUS ) and transpapillary diagnosis. EUS ‐guided fine‐needle aspiration cytology and EUS ‐guided fine needle‐based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non‐mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules ( MN ) in intraductal papillary mucinous neoplasms ( IPMN ). Contrast‐enhanced harmonic EUS ( CH ‐ EUS ), as an add‐on to EUS , is useful for identifying and characterizing MN . Recent studies show that CH ‐ EUS has a sensitivity of 60–100% and a specificity of 75–92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN . A recent meta‐analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN . Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.