Cystic Pancreatic Lesions Diagnosed on Endoscopic Ultrasound: Frequency, Morphology, and Factors Associated with Malignant Nature of these Lesions.

BACKGROUND

Cystic pancreatic lesions (CPLs) constitute an important part of pancreatic diseases. This study aimed to identify the frequency of the various CPLs evaluated through endoscopic ultrasound (EUS) and factors associated with malignant histology of the cyst.

MATERIALS AND

METHODS

In this observational study, all patients with CPLs referred for EUS were included. All extra-pancreatic fluid collections were excluded. The frequency, morphology, and demographics of patients with CPLs were recorded. Factors associated with malignant histology of the cyst were statistically analyzed.

RESULTS

Of the total 56 patients included in the study, females were more common (34; 60.7%) than males, and the mean age was 46.5 (±14.6) years. The majority of the CPLs were pure cystic lesions 41 (73.2%), while the remaining were solid-cystic lesions 15 (26.8%). The majority of the CPLs were located in the head 30 (53.6%), followed by the body 14 (25%) of the pancreas. The commonest CPLs were: Serous cystadenoma (SCN) 11 (19.6%), intraductal papillary neoplasm (IPMN) 10 (17.9%), mucinous cystic neoplasm (MCN) 9 (16.1%), associated with a specific disease 7 (12.5%), malignancy 7 (12.5%), pancreatitis 6 (10.7%), simple cyst 5 (8.9%) and solid pseudopapillary tumor 1 (1.8%). Malignancy was detected among seven patients with CPL: Cystic degeneration of pancreatic ductal adenocarcinoma 3, neuroendocrine cancer 3, and IPMN with malignant transformation 1. Factors associated with the malignant nature of cyst were age >55 (p = 0.029), a solid-cystic morphology (p = 0.001), and size >4 cm (p = 0.002) on univariate analysis; while solid-cystic morphology (p = 0.036) on multivariate analysis.

CONCLUSION

The commonest CPLs evaluated through EUS were SCN, followed by IPMN, MCN, and those associated with a specific disease. The chance of a cystic pancreatic lesion being malignant is higher if it has a solid-cystic morphology.