To fine needle aspiration or not? An endosonographer's approach to pancreatic cystic lesions

DYK But, Jan-werner Poley

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6 Citations (Scopus)


Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is an established diagnostic tool in the Management of pancreatic cystic lesions (PCLs). Due to the proximity to the target lesion, the fine diagnostic needle travels through only minimal normal tissues. The risks of bleeding, pancreatitis and infection are small. Valuable diagnostic morphological information can be obtained by EUS before the use of FNA. The additional cytopathologic and cyst fluid analysis for the conventional markers such as amylase, carcinoembryonic antigen. (CEA) and CA19.9 improves the diagnostic capability. Pancreatic cyst fluid CEA concentration of 192 ng/mL is generally the most agreed cutoff to differentiate mucinous from non-mucinous lesion. A fluid amylase level of <250 IU/L excludes the diagnosis of pseudocyst. Technical tips of EUS-FNA and the limitations of the procedure are discussed. Premising technique and FNA needle modifications have been described to improve the diagnostic yield at the cytopatholoegic analysis. The use of novel cyst fluid proteomics and deoxyribonucleic acid based biomarkers of the PCLs are reviewed. Although it is considered a safe procedure, EUS-FNA is not a routine in every patient. Recommendations of the role of EUS-FNA at various Common clinical scenarios are discussed.
Original languageUndefined/Unknown
Pages (from-to)82-90
Number of pages9
JournalEndoscopic Ultrasound
Issue number2
Publication statusPublished - 2014

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