EUS,+lesions,+cysts,+PPV,+NPV

“Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis.” Twelve studies were included, which gathered data of 450 patients. Cysts with an amylase concentration <250 U/L were SCA, MCA, or MCAC (sensitivity 44%, specificity 98%) and, thus, virtually excluded PC. A carcinoembryonic antigen (CEA) <5 ng/mL suggested a SCA or PC (sensitivity 50%, specificity 95%). A CEA >800 ng/mL strongly suggested MCA or MCAC (sensitivity 48%, specificity 98%). A carbohydrate-associated antigen (CA) 19-9 <37 U/mL strongly suggested PC or SCA (sensitivity 19%, specificity 98%). Cytologic examination revealed malignant cells in 48% of MCAC (n = 111). Helps differentiate pancreatic benign lesions/cysts from cancerous ones. EUS is an ideal screening method because of its ability to get an image of a lesion in close proximity.

2 types of cysts: serous and mucinous. Mucinous cystadenomas are premalignant pancreatic cystic neoplasms. Serous cystadenomas are benign and do not have to be resected.

[|Full-size table] //PPV,// Positive predictive value; //NPV,// negative predictive value; //CEA,// carcinoembryonic antigen; //CA,// carbohydrate-associated antigen; //SCA,// serous cystadenoma; //MCA,// mucinous cystadenoma; //MCAC,// mucinous cystadenocarcinoma; //PC,// pseudocysts.
 * ** Cutoff ** || ** Diagnosis ** || ** Sensitivity (%) ** || ** Specificity (%) ** || ** PPV (%) ** || ** NPV (%) ** || ** Accuracy (%) ** ||
 * Amylase < 250 U/L || SCA, MCA, MCAC || 44 || 98 || 98 || 53 || 65 ||
 * CEA < 5 ng/mL || SCA, PC || 50 || 95 || 94 || 55 || 67 ||
 * CEA > 800 ng/mL || MCA, MCAC || 48 || 98 || 94 || 75 || 79 ||
 * CA 19-9 < 37 U/mL || SCA, PC || 19 || 98 || 94 || 38 || 46 ||
 * Cytology: malignant cells || MCAC || || 48 || 100 (?) || || ||

This study took all the factors listed above and made cut offs where each indicator showed benign or malignant cells with varying sensitivity but high specificity. In asymptomatic patients, in patients with an increased surgical risk, and in patients in whom there is a diagnostic uncertainty about the presence of a PC, it is important to distinguish premalignant or malignant tumors, such as MCA and MCAC from benign tumors, such as PC and SCA. Theoretically, a combination of EUS morphology, cytology, and tumor markers should increase the accuracy. Further investigations of pancreatic cyst fluid studies, particularly in the field of molecular genetics, might allow for improved diagnostic accuracies, thereby allowing us to better segregate benign and premalignant or malignant diseases and tailor management plans. [|Prospective evaluation of the pancreatic secretion of immunoreactive carcinoembryonic antigen, enzyme, and bicarbonate in patients suspected of having pancreatic cancer.] pancreatic cancer + pancreas* secretion search, 22. page 3. Academic Journal[|Virtual pancreatoscopy of pancreatic cancer.] It is concluded that virtual //**endoscopy**// for //**pancreatic**// //**cancer**// has potential clinical utility.

Early detection of pancreatic cancer: why, who, and how to screen. The three known precursor lesions are pancreatic intraductal neoplasia, intraductal pancreatic mucinous neoplasm, and mucinous cystic neoplasm.

For screening to be cost effective, a recent study estimated that the probability of detecting preinvasive or invasive disease needs to be 16% or greater. Familial pancreatic cancer: 2 first-degree relatives affected 18 3 first-degree relatives affected 57 Hereditary pancreatic cancer syndromes: BRCA2 mutation 5.9 Familial atypical multiple mole melanoma 16 Peutz-Jeghers Syndrome 36 Hereditary pancreatitis 50 Cigarette smoking: Positive family history of pancreatic cancer 3.7 Diabetes > 20 years 2 EUS-guided FNA had a sensitivity of 94% and accuracy of 92% for detecting malignant disease in patients.
 * Risk Factor Relative Risk **