Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study

Background and study aims: Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs.

Patients and methods: In total, 37 patients with 39 CPLs measuring at least 20 mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL.

Results: Cytobrushings were more likely to detect ICM than the EUS-FNA method (P = 0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8 %): one postbrushing bleeding and two acute pancreatitis.

Conclusions: Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients.

References

• 1 Brugge W R, Lauwers G Y, Sahani D. et al . Cystic neoplasms of the pancreas.  N Engl J Med. 2004;  351 1218-1226
• 2 Warshaw A L, Rutledge P L. Cystic tumors mistaken for pancreatic pseudocysts.  Ann Surg. 1987;  205 393-398
• 3 Brugge W R, Lewandrowski K, Lee-Lewandrowski E. et al . Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.  Gastroenterology. 2004;  126 1330-1336
• 4 Al-Haddad M, Raimondo M, Woodward T. et al . Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study.  Gastrointest Endosc. 2007;  65 894-898
• 5 Brugge W R. The incidental pancreatic cyst on abdominal computerized tomography imaging: diagnosis and management.  Clin Gastroenterol Hepatol. 2008;  6 140-144
• 6 Brandwein S L, Farrell J J, Centeno B A, Brugge W R. Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS.  Gastrointest Endosc. 2001;  53 722-727
• 7 Frossard J L, Amouyal P, Amouyal G. et al . Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions.  Am J Gastroenterol. 2003;  98 1516-1524
• 8 Sedlack R, Affi A, Vazquez-Sequeiros E. et al . Utility of EUS in the evaluation of cystic pancreatic lesions.  Gastrointest Endosc. 2002;  56 543-547
• 9 Pais S A, Attasaranya S, Leblanc J K. et al . Role of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms: correlation with surgical histopathology.  Clin Gastroenterol Hepatol. 2007;  5 489-495
• 10 Emerson R E, Randolph M L, Cramer H M. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of intraductal papillary mucinous neoplasm of the pancreas is highly predictive of pancreatic neoplasia.  Diagn Cytopathol. 2006;  34 457-462
• 11 Recine M, Kaw M, Evans D B, Krishnamurthy S. Fine-needle aspiration cytology of mucinous tumors of the pancreas.  Cancer. 2004;  102 92-99
• 12 Lai R, Stanley M W, Bardales R. et al . Endoscopic ultrasound-guided pancreatic duct aspiration: diagnostic yield and safety.  Endoscopy. 2002;  34 715-720
• 13 O'Toole D, Palazzo L, Arotcarena R. et al . Assessment of complications of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 470-474
• 14 Lee L S, Saltzman J R, Bounds B C. et al . EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors.  Clin Gastroenterol Hepatol. 2005;  3 231-236
• 15 Al-Haddad M, Wallace M B, Woodward T A. et al . The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study.  Endoscopy. 2008;  40 204-208
• 16 Kawamoto S, Lawler L P, Horton K M. et al . MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma.  AJR Am J Roentgenol. 2006;  186 687-695
• 17 Kubo H, Chijiiwa Y, Akahoshi K. et al . Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography.  Am J Gastroenterol. 2001;  96 1429-1434
• 18 Schmidt C M, White P B, Waters J A. et al . Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology.  Ann Surg. 2007;  246 644-651; discussion 651 – 644
• 19 Tanaka M, Chari S, Adsay V. et al . International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.  Pancreatology. 2006;  6 17-32