Original Article
 
Advantage of endoscopic-ultrasound-fine-needle aspiration associated to Sendai clinical guidelines in detecting the malignant risk in patients with undetermined pancreatic cysts: Long-term follow-up
Pietro Gambitta1, Paolo Aseni2, Paola Fontana1, Emilia Bareggi1, Edoardo Forti4, Alberto Tringali4, Francesco Molteni3, Maurizio Vertemati5
1Unità Operativa di Gastroenterologia ed Endoscopia Digestiva Ospedale Luigi Sacco, Milano, Italy.
2Dipartimento di Emergenza Urgenza Medicina d'Urgenza e Pronto Soccorso, ASST, Grande Ospedale Metropolitano Niguarda, Milano, Italy.
3Università Statale di Milano, Dipartimento di Scienze Sociali e Politiche, Milano, Italy.
4Endoscopia Digestiva e Interventistica, Ospedale Niguarda Ca' Granda, Milano, Italy.
5Dipartimento di Scienze Biomediche e Cliniche "L. Sacco" Università degli Studi di Milano, Italy.

Article ID: 100062IJHPDPG2016
doi:10.5348/ijhpd-2016-62-OA-18

Address correspondence to:
Paolo Aseni
Dipartimento di Emergenza Urgenza
Medicina d'Urgenza e Pronto Soccorso, ASST Grande Ospedale Metropolitano Niguarda
Piazza Ospedale Maggiore 3, 20162 Milano
Italy

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How to cite this article
Gambitta P, Aseni P, Fontana P, Bareggi E, Forti E, Tringali A, Molteni F, Vertemati M. Advantage of endoscopic-ultrasound-fine-needle aspiration associated to Sendai clinical guidelines in detecting the malignant risk in patients with undetermined pancreatic cysts: Long-term follow-up. Int J Hepatobiliary Pancreat Dis 2016;6:100–107.


Abstract
Aims: Contradictory information exists on whether different clinical guidelines are effective in detecting the malignant risk in patients with pancreatic cysts. We have retrospectively evaluated the accuracy and the long-term outcome in patients with pancreatic cysts with a diameter ≥ 2 cm when indication for surgery was established by clinical evaluation of their malignant risk according to Sendai Clinical Guidelines associated to endoscopic-ultrasound-fine-needle aspiration.
Material and Methods: Patients with pancreatic cysts with a diameter ≥2 cm were evaluated for their potential malignant risk by endoscopic-ultrasound-fine-needle aspiration associated to the clinical evaluation by Sendai Clinical Guidelines. Long-term outcome and comparison in patients survival as well as the accuracy in detecting malignancies were evaluated with the combined clinical and endoscopic evaluation.
Results: Two hundred eighteen patients with pancreatic cysts were observed during a nine-year period of the study and 74 of them (33.9%) presenting with a pancreatic cyst ≥2 cm were eligible for the study. Fourteen malignant neoplasms (18.9%) were detected. The accuracy in detecting malignancy of combined clinical and endoscopic evaluation was very high (0.99). The five-year survival rates for patients who underwent surgery with benign and malignant pancreatic cysts and for patients in observational follow-up were similar (70% and 85%). The cohort of patients with malignant pancreatic cysts with ductal adenocarcinoma showed a five-year survival rate of 41%.
Conclusion: Endoscopic ultrasound fine-needle aspiration associated to Sendai clinical guidelines showed a high accuracy in detecting malignant risk in patients with pancreatic cysts with a diameter ≥ 2 cm. allowing appropriate selection for surgical treatment with satisfactory long-term survival.

Keywords: Diagnostic imaging, Pancreatic cancer, Pancreatic carcinoma, Pancreatic neoplasm, Pancreatic pseudocyst


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Author Contributions:
Pietro Gambitta – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paolo Aseni – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Paola Fontana – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Emilia Bareggi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Edoardo Forti – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Alberto Tringali – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Francesco Molteni – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Maurizio Vertemati – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Pietro Gambitta et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.