EUS-FNA of Cystic Pancreatic Tumors

Due to limitations with diagnostic imaging alone, endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) of pancreatic cyst fluid provides additional information to help characterize these lesions as inflammatory, benign, premalignant, or malignant. When greater than 2 mL of cyst fluid is obtained from EUS-FNA, the following should be examined: cytology, carcinoembryonic antigen (CEA), and amylase. Pseudocyst fluid generally has thin viscosity, is yellow to brown in color, and has low CEA and elevated amylase levels. Fluid from serous cystic neoplasms is thin, colorless with a low CEA (<200 ng/mL), and low amylase levels. Aspirates from mucinous cystic neoplasms (including intraductal papillary tumors [IPMTs]) are generally viscous with an elevated CEA (>200 ng/mL) but variable amylase levels. Complications following EUS-FNA of these lesions occur in 1% to 2% of patients and may be minimized by performing only one pass, completely aspirating the punctured cyst, and administration of antibiotics.