The diagnostic role of endoscopic ultrasonography, magnetic resonance imaging and computed tomography in the assessment of pancreatic cystic lesions

Beyza Olcay Öztürk 1, Nergiz Ekmen 2 * , Mehmet Cindoruk 2, Güner Kılıç 2, Ali Karataş 2, Hadi Sasani 3, Murat Uçar 4
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1 Department of Internal Medicine , Ilgaz State Hospital, Çankırı, Turkey
2 Department of Gastroenterology, Gazi University, Faculty of Medicine, Ankara, Turkey
3 Department of Radiology, Tekirdağ Namık Kemal University, Faculty of Medicine, Tekirdag, Turkey
4 Department of Radiology, Gazi University, Faculty of Medicine, Ankara, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 4, pp. 69-74.
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Aim: To reveal the malignancy rates of pancreatic cyctic lesions and success rates of computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) in differentiating between malignant vs non-malignant cystic lesions of the pancreas.

Methods: In this study, 138 patients  were included. CT, MRI, EUS and pathology reports of the related patients were scrutinised and descriptive statistical methods were used. Sensitivity and specificity values of  CT, MRI and EUS were calculated by taking the postoperative histopathology results as the gold standard.

Results: In assessment the data of patients with neoplastic or non-neoplastic pancreatic cysts,  the highest sensitivity, specificity and diagnostic accuracy in the malignant-benign distinction of the lesions was determined in CT.   Although EUS had similar sensitivity and diagnostic accuracy rates as CT, its specificity was considered to be lower than CT.  MRI had lower sensitivity, specificity and diagnostic accuracy rates compared to both of modalities (EUS and CT). The sensitivity, specificity and diagnostic accuracy of EUS guided FNA biopsies were found to be quite low than other diagnostic modalities.

Conclusion: While CT and EUS showed high correlation with each other in terms of overall diagnostic compliance, there was a moderate correlation between MRI and EUS.


Olcay Öztürk B, Ekmen N, Cindoruk M, Kılıç G, Karataş A, Sasani H, et al. The diagnostic role of endoscopic ultrasonography, magnetic resonance imaging and computed tomography in the assessment of pancreatic cystic lesions. J CLIN MED KAZ. 2021;18(4):69-74.


  • de Jong K, Nio CY, Hermans JJ, Dijkgraaf MG, Gouma DJ, van Eijck CH, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol. 2010;8(9):806-11. doi: 10.1016/j.cgh.2010.05.017.
  • Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am J Gastroenterol. 2018;113(4):464-79. doi: 10.1038/ajg.2018.14.
  • Gardner TB, Glass LM, Smith KD, Ripple GH, Barth RJ, Klibansky DA, et al. Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol. 2013;108(10):1546-50. doi: 10.1038/ajg.2013.103.
  • Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):824-48.e22. doi: 10.1053/j.gastro.2015.01.014.
  • Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191(3):802-7. doi: 10.2214/AJR.07.3340.
  • Fernández-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138(4):427-3; discussion 433-4. doi: 10.1001/archsurg.138.4.427.
  • Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system: World Health Organization;2010.
  • Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126(5):1330-6. doi: 10.1053/j.gastro.2004.02.013.
  • Attasaranya S, Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. Jop. 2007;8:553-63.
  • Cho CS, Russ AJ, Loeffler AG, Rettammel RJ, Oudheusden G, Winslow ER, Weber SM. Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol. 2013;20(9):3112-9. doi: 10.1245/s10434-013-2986-6.
  • Mizuno S, Isayama H, Nakai Y, Yoshikawa T, Ishigaki K, Matsubara S, et al. Prevalence of Pancreatic Cystic Lesions Is Associated With Diabetes Mellitus and Obesity: An Analysis of 5296 Individuals Who Underwent a Preventive Medical Examination. Pancreas. 2017;46(6):801-805. doi: 10.1097/MPA.0000000000000833.
  • Hoffman RL, Gates JL, Kochman ML, Ginsberg GG, Ahmad NA, Chandrasekhara V, et al. Analysis of cyst size and tumor markers in the management of pancreatic cysts: support for the original Sendai criteria. J Am Coll Surg. 2015;220(6):1087-95. doi: 10.1016/j.jamcollsurg.2015.02.013.
  • Spinelli KS, Fromwiller TE, Daniel RA, Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004;239(5):651-7; discussion 657-9. doi: 10.1097/01.sla.0000124299.57430.ce.
  • Haghighi M, Sethi A, Tavassoly I, Gonda TA, Poneros JM, McBride RB. Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. J Pathol Inform. 2019;10:34. doi: 10.4103/jpi.jpi_32_19.
  • Garcea G, Ong SL, Rajesh A, Neal CP, Pollard CA, Berry DP, et al. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology. 2008;8(3):236-51. doi: 10.1159/000134279.
  • Gerke H, Jaffe TA, Mitchell RM, Byrne MF, Stiffler HL, Branch MS, et al. Endoscopic ultrasound and computer tomography are inaccurate methods of classifying cystic pancreatic lesions. Dig Liver Dis. 2006;38(1):39-44. doi: 10.1016/j.dld.2005.09.023.
  • Sedlack R, Affi A, Vazquez-Sequeiros E, Norton ID, Clain JE, Wiersema MJ. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc. 2002;56(4):543-7. doi: 10.1067/mge.2002.128106.
  • Lu X, Zhang S, Ma C, Peng C, Lv Y, Zou X. The diagnostic value of EUS in pancreatic cystic neoplasms compared with CT and MRI. Endosc Ultrasound. 2015;4(4):324-9. doi: 10.4103/2303-9027.170425.
  • Lee YS, Paik KH, Kim HW, Lee JC, Kim J, Hwang JH. Comparison of Endoscopic Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging for Pancreas Cystic Lesions. Medicine (Baltimore). 2015;94(41):e1666. doi: 10.1097/MD.0000000000001666.
  • Gillis A, Cipollone I, Cousins G, Conlon K. Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. HPB (Oxford). 2015;17(5):377-86. doi: 10.1111/hpb.12364.
  • Wang QX, Xiao J, Orange M, Zhang H, Zhu YQ. EUS-Guided FNA for Diagnosis of Pancreatic Cystic Lesions: a Meta-Analysis. Cell Physiol Biochem. 2015;36(3):1197-209. doi: 10.1159/000430290.
  • Suzuki R, Thosani N, Annangi S, Guha S, Bhutani MS. Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: a systematic review and meta-analysis. Pancreatology. 2014;14(5):380-4. doi: 10.1016/j.pan.2014.07.006.
  • Polkowski M, Larghi A, Weynand B, Boustière C, Giovannini M, Pujol B, et al; European Society of Gastrointestinal Endoscopy (ESGE). Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012;44(2):190-206. doi: 10.1055/s-0031-1291543.
  • Storch I, Jorda M, Thurer R, Raez L, Rocha-Lima C, Vernon S, et al. Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc. 2006;64(4):505-11. doi: 10.1016/j.gie.2006.02.056.
  • T Turhan N, Aydog G, Ozin Y, Cicek B, Kurt M, Oguz D. Endoscopic ultrasonography-guided fine-needle aspiration for diagnosing upper gastrointestinal submucosal lesions: a prospective study of 50 cases. Diagn Cytopathol. 2011;39(11):808-17. doi: 10.1002/dc.21464.
  • S Soyer OM, Baran B, Ormeci AC, Sahin D, Gokturk S, Evirgen S, et al. Role of biochemistry and cytological analysis of cyst fluid for the differential diagnosis of pancreatic cysts: A retrospective cohort study. Medicine (Baltimore). 2017;96(1):e5513. doi: 10.1097/MD.0000000000005513.
  • Cao S, Hu Y, Gao X, Liao Q, Zhao Y. Serum Carbohydrate Antigen 19-9 in Differential Diagnosis of Benign and Malignant Pancreatic Cystic Neoplasms: A Meta-Analysis. PLoS One. 2016;11(11):e0166406. doi: 10.1371/journal.pone.0166406.