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Giriş ve Amaç: Pankreas kistlerinin teşhis sıklığı, günümüzde bilgisayarlı tomografi ve manyetik rezonans görüntüleme gibi kesitsel görüntüleme yöntemlerinin yaygın kullanımı nedeni ile giderek artmaktadır. Pankreas kistik lezyonlarının tedavisini yönetmek çoğu zaman klinisyen için zordur. Bu nedenle ayırıcı tanı yapılması için; öykü, klinik, laboratuvar, radyolojik görüntüleme, endoskopik ultrasonografi, endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi ile alınan kist sıvı analizi ve sitopatoloji verilerinin değerlendirilmesi önemlidir. Bu çalışmanın amacı; pankreasın neoplastik kistlerinde klinik, laboratuvar, radyolojik, endosonografik ve patolojik incelemelerin tanıya katkısının psödokistlerle karşılaştırılarak araştırılmasıdır. Gereç ve Yöntem: Çalışmaya Temmuz 2009-Ağustos 2017 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Anabilim Dalı Gastroenteroloji Kliniği Endoskopi ünitesinde pankreas kistik lezyonu nedenli endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi ile değerlendirildikten sonra cerrahi operasyon geçiren ve patoloji sonucu “neoplastik kist” olan 30 hasta ile akut pankreatit öyküsü olup pankreas kistik lezyon nedenli endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi değerlendirilmesi sonrası endoskopik ultrasonografi raporlarında “psödokist” tanısı konulan 46 hasta dahil edilmiştir. Hastaların; demografik verileri, klinik özellikleri, laboratuvar verileri, radyolojik/ endoskopik ultrasonografi görüntü raporları ve patolojik inceleme sonuçları retrospektif olarak değerlendirilmiştir. Bulgular: Pankreas kistik lezyonu nedenli kiste yönelik cerrahi operasyon geçiren 30 hastanın cerrahi patoloji sonuçları; 15 hastanın (%50) intraduktal papiller müsinöz neoplazi, 6 hastanın (%20) kistik adenokarsinom, 4 hastanın (%13.3) solid psödopapiller neoplazm, 3 hastanın (%10) müsinöz kistik neoplazi ve 2 hastanın (%6.7) seröz kistik neoplazi şeklinde idi. Endoskopik ultrasonografi incelemesinde; pankreasın ve kistlerin morfolojik özelliklerine bakıldığında; neoplastik kist grubunda 2 (%6.7) hastada kronik pankreatit bulguları, 6 (%20) hastada ana pankreas kanalında genişleme, 2 (%6.7) hastada yan dal pankreas kanallarında genişleme, 6 (%20) hastada kistin pankreatik kanal ile bağlantılı olduğu, 9 (%30) hastada septasyon, 5 (%16.7) hastada lobulasyon, 5 (%16.7) hastada kalsifikasyon, 4 (%13.3) hastada kist duvarında kalınlaşma mevcuttu. Psödokist grubunda ise 1 (%2.2) hastada septasyon, 1 (%2.2) hastada lobulasyon mevcuttu. Endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi ile alınan kist sıvısı analizinde; neoplastik kist grubunda kist analizinde bakılan amilaz ortalama değeri; 28808.8±60961.01 U/L ve karsinoembriyojenik antijen ortalama değeri: 1055.29±1548.14 ng/mL olarak; psödokist grubunun kist analizinde ise amilaz ortalama değeri: 28246.13±29858.56 U/L ve karsinoembriyojenik antijen ortalama değeri: 7.31±10.02 ng/mL olarak saptanmıştır. Endoskopik ultrasonografi; neoplastik kistlerin 13’ünü (%43.3) tanısal olarak doğru tanımlamıştı. Müsinöz kistlerde; endoskopik ultrasonografinin tanısal olarak ayırt ediciliğine endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi bulgularından (sitopatoloji, müsin, string sign ve karsinoembriyojenik antijen >192 ng/mL ) herhangi birinin veya hepsinin pozitif olmasını eklediğimizde; tanısal duyarlılık %88.9’a varan oranlara ulaşmaktadır. Sonuç: Pankreasın neoplastik kistlerinin tanısında endoskopik ultrasonografi ve endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi en yüksek tanısal duyarlılığa sahip yöntemdir. Buna rağmen %15’e varan oranda neoplastik/benign kist ayrımını yapmada yeterli olmamaktadır. Radyolojik yöntemlerle birlikte kullanımı tanısal doğruluğu arttırmaktadır. Pankreas kisti bulunan diyabetik hastalarda serum kanser antijen 19-9 düzeylerinin bakılması neoplastik kist tanısında yardımcı olabilir.
Background and aims: The identification frequency of pancreatic cystic lesions are increasing day by day due to the widespread use of cross-sectional imaging methods such as computed tomography and magnetic resonance imaging. Pancreatic cystic lesions are simply divided into two main classes: non-neoplastic (e.g. pseudocysts) and neoplastic cysts. Managing the treatment of pancreatic cystic lesions is difficult for the clinic; therefore, in order to make differential diagnosis; medical history, clinical, laboratory, radiological imaging, endoscopic ultrasonography, evaluation of cyst fluid analysis and cytopathology data obtained with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration is important. The objective of this study was to investigate clinical, laboratory, radiological, endoscopic ultrasound and pathological examinations of the pancreatic cystic neoplasms by comparing the diagnostic contribution with pseudocysts. Materials and Method: 30 patients who underwent surgical operation and were diagnosed pathologic "neoplastic cyst" of pancreatic cystic lesions with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy evaluation in the gastroenterology clinic of the 9th September Medical Faculty between July 2009 and August 2017 with 46 patients who history of acute pancreatitis with a diagnosis of "pseudocyst" were included in the endoscopic ultrasonography reports after evaluation of endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy with pancreatic cystic lesions, were included in the study. The demographic characteristics of the patients, clinical features, laboratory data, radiological/endoscopic ultrasonography image reports and pathological examination results were investigated retrospectively. Results: Surgical pathology results of 30 patients for pancreatic cystic lesions were intraductal papillary mucinous neoplasm in 15 patients (%50), cystic adenocarcinoma in 6 patients (%13), Solid pseudopapillary neoplasm in 4 patients (%13.3), mucinous cystic neoplasm in 3 patients (10%) and serous cystic neoplasm in 2 patients (%6.7). In the endoscopic ultrasonography; when the morphological characteristics of the pancreas and cysts are examined; 2 patients (%6. 7) in the neoplastic cyst group had chronic pancreatitis, 6 patients (%20) had expansion in main pancreatic duct, 2 patients (%6.7) had enlarged in the side branch pancreatic duct, 6 patients (%20) had cysts were associated with the pancreatic duct, 9 patients (%30) had septation, 5 patients (% 16.7) had lobularity, 5 patients (% 16.7) had calcification, 4 patients (%13.3) had thick of the cyst wall. As for in the pseudocyst group; 1 patient (%2.2) had septation and 1 patient (%2.2) had lobularity. In cyst fluid analysis with endoscopic ultrasonography-fine needle aspiration biopsy: in the cyst analysis of the neoplastic cyst group average amylase was 28808.8±60961.01 U/L and average Carcinoembryonic antigen value was 1055.29±1548. 14 ng/mL; in the cyst analysis of the pseudocyst group average amylase value was 28246.13±29858.56 U/L and average carcinoembryonic antigen value was 7.31±10.02 ng/mL. Endoscopic ultrasonography diagnosed 13 (43.3%) of the neoplastic cysts correctly. In mucinous cysts; when we add the diagnostic discrimination of endoscopic ultrasonography to any of the endoscopic ultrasonography-fine needle aspiration biopsyfindings (cytopathology, mucin, string sign and Carcinoembryonic antigen > 192 ng/mL) or all of them positive, the diagnostic sensitivity reaches up to 88.9%. Conclusion: In the diagnosis of neoplastic cysts of the pancreas; endoscopic ultrasonography and endoscopic ultrasonography-fine needle aspiration biopsyare the method with the highest diagnostic sensitivity. However, up to 15% is not sufficient to distinguish neoplastic/benign cyst. Its use with radiological methods increases diagnostic accuracy. Serum cancer antigen19-9 levels in diabetic patients with pancreatic cysts may be helpful in diagnosing neoplastic cysts.
Background and aims: The identification frequency of pancreatic cystic lesions are increasing day by day due to the widespread use of cross-sectional imaging methods such as computed tomography and magnetic resonance imaging. Pancreatic cystic lesions are simply divided into two main classes: non-neoplastic (eg: pseudocysts) and neoplastic cysts. Managing the treatment of pancreatic cystic lesions is difficult for the clinician; therefore, in order to make differantial diagnosis; medical history, clinical, laboratory, radiological imaging, endoscopic ultrasonography, evaluation of cyst fluid analysis and cytopathology data obtained with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration is important. The objective of this study was to investigate clinical, laboratory, radiological, endoscopic ultrasound and pathological examinations of the pancreatic cystic neoplasms by comparing the diagnostic contribution with pseudocysts. Materials and Method: 30 patients who underwent surgical operation and were diagnosed pathologic "neoplastic cyst" of pancreatic cystic lesions with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy evaluation in the gastroenterology clinic of the Dokuz Eylül Medical Faculty between July 2009 and August 2017 with 46 patients who history of acute pancreatitis with a diagnosis of ‘’pseudocyst’’ were included in the endoscopic ultrasonography reports after evaluation of endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy with pancreatic cystic lesions, were icluded in the study. The demographic characteristics of the patients, clinical features, laboratory data, radiological/endoscopic ultrasonography image reports and pathological examination results were investigated retrospectively. Results: Surgical pathology results of 30 patients for pancreatic cystic lesions were intraductal papillary mucinous neoplasm in 15 patients (%50), cystic adenocarcinoma in 6 patients (%13), Solid pseudopapillary neoplasm in 4 patients (%13.3), mucinous cystic neoplasm in 3 patients (10%) and serous cystic neoplasm in 2 patients (%6.7). In the endoscopic ultrasonography; when the morphological characteristics of the pancreas and cysts are examined; 2 patients (%6.7) in the neoplastic cyst group had chronic pancreatitis, 6 patients (%20) had expansion in main pancreatic duct, 2 patients (%6.7) had enlarged in the side branch pancreatic duct, 6 patients (%20) had cysts were associated with the pancreatic duct, 9 patients (%30) had septation, 5 patients (% 16.7) had lobularity, 5 patients (% 16.7) had calcification, 4 patients (%13.3) had thick of the cyst wall. As for in the pseudocyst group; 1 patient (%2.2) had septation and 1 patient (%2.2) had lobularity. In cyst fluid analysis with endoscopic ultrasonography-fine needle aspiration biopsy: in the cyst analysis of the neoplastic cyst group mean amylase was 28808.8±60961.01 U/L and mean Carcinoembryonic antigen value was 1055.29±1548.14 ng/mL; in the cyst analysis of the pseudocyst group mean amylase value was 28246.13±29858.56 U/L and mean Carcinoembryonic antigen value was 7.31±10.02 ng/mL. Endoscopic ultrasonography diagnosed 13 (%43.3) of the neoplastic cysts correctly. In mucinous cysts; when we add the diagnostic discrimination of endoscopic ultrasonography to any of the endoscopic ultrasonography-fine needle aspiration biopsyfindings (cytopathology, mucin, string sign and Carcinoembryonic antigen > 192 ng/mL) or all of them positive, the diagnostic sensitivity reaches up to %88.9. Conclusion: In the diagnosis of neoplastic cysts of the pancreas; endoscopic ultrasonography and endoscopic ultrasonography-fine needle aspiration biopsyare the method with the highest diagnostic sensitivity. However, up to %15 is not sufficient to distinguish neoplastic/benign cyst. Its use with radiological methods increases diagnostic accuracy. Serum cancer antigen19-9 levels in diabetic patients with pancreatic cysts may be helpful in diagnose neoplastic cyst.
Field : Sağlık Bilimleri
Journal Type : Uluslararası
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