الفهرس 
Introduction & Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Pancreatic cystic lesions include the most common pseudocysts and a variety of cystic lesions with different biologic and pathologic characteristics. An accurate diagnosis of the cyst type as well as assessment of the presence or absence of malignancy can be very challenging. Preoperative differential diagnosis of the cystic lesions of the pancreas may be difficult because there are no reliable clinical or radiologic criteria to assist in making the differentiation; particularly in recognizing mucinous and/or malignant tumors in which a surgical resection is mandatory.
EUS provides a superior alternative to CT and MRI to characterize cystic lesions, with the capacity to identify ductal communication and the presence of mural nodules or solid components. EUS-guided FNA for analysis of the pancreatic cyst fluid can improve the diagnostic performance of EUS morphology more than EUS alone. Cyst fluid can be analyzed for tumor markers, cytology, mucins (MUCs), DNA analysis, viscosity and chemistries (most commonly amylase and lipase).
The aim of our study was to evaluate the diagnostic accuracy of the tumor marker CA72-4 obtained by EUS-FNA for differential diagnosis of the pancreatic cysts.
Seventy-six patients with pancreatic cystic lesions, diagnosed by triphasic abdominal CT and/or MRI were enrolled in our study. They were selected from the referees of Endosonography Unit of the Internal Medicine Department of Kaser Al-Ainy University Hospital from the period of January 2017 to October 2019.
All patients were subjected to through clinical history and examination and Endoscopic ultrasound. EUS-guided FNA of the pancreatic cyst fluid was done and analyzed for cytopathology, mucin staining, enzymatic and biochemical analysis for CF amylase, CF CEA and CF CA72-4.
We found the mean + SD age of the studied patients with pancreatic cystic lesions was (49.34 + 11.72) years. They were 31 (40.8%) males and 45 (59.2%) females.
The cytopathological diagnosis of pancreatic cystic lesions in our studied patients showed that 27 (35.5%) were inflammatory cysts, while 49 (64.5%) were true cysts. The true cysts include serous cystadenomas 15 (19.7%), IPMNs 14 (18.4%), mucinous cystadenomas 12 (15.8%); mucinous cystadenocarcinomas 2 (2.6%), pancreatic adenocarcinomas 3 (3.9%) and cystic lymphangiomas 3 (3.9%). Also, it was found that 48 (63.2%) of the pancreatic cysts were mucin negative e.g., 27 (56.2%) inflammatory and 21 (43.8%) true, while 28 (36.8%) were mucin positive true cysts.
There was a statistically significant association between the cytopathological diagnosis and mucin staining of the pancreatic cysts (P value: <0.001). Also, we found a significant relation between the endosonographic findings namely the mural nodules and pancreatic duct dilatation with the mucinous cysts (P value: 0.004 and <0.001). Also, we found a statistically significant relation between the endosonographic findings e.g., mural nodules, turbidity of the cyst fluid, lymph nodes, pancreatic duct dilatation and the cytopathological diagnosis (P value: 0.008, 0.048, 0.02 and <0.001 respectively).
On the other hand, we found that CF CEA was the only cyst fluid marker with a statistically significant relation with mucin staining of the pancreatic cysts (P value: 0.001). No significant relation was found between mucin staining and CF CA 72-4 nor CF amylase (P value: 0.74 and 0.06 respectively). Also, there was a statistically significant relation between true pancreatic cysts and CF CEA (P value: 0.017). In addition, we found that CF CEA was the only cyst fluid marker with a statistically significant relation with the cytopathological diagnosis of the pancreatic cystic lesions (P value: 0.03).
As regards the diagnostic accuracy of cystic fluid markers for detection of mucinous pancreatic cysts we found that:
• The diagnostic accuracy of CF CEA was 72% at a cut-off value of >18 ng/mL, with a sensitivity of 60.71%, specificity of 81.25%, PPV of 65.4%, NPV of 78% and AUC of 0.726.
• The diagnostic accuracy of CF CA 72-4 was 52% at a cut-off value of >3.0393 U/mL with a sensitivity of 85.17%, specificity of 33.33%, PPV of 42.9%, NPV of 80% and AUC of 0.523.
• The diagnostic accuracy of CF amylase was 63% at a cut-off value >270 IU/L with a sensitivity of 64.29 %, specificity of 70.83%, PPV of 56.3%, NPV of 77.3 and AUC of 0.632.
• The diagnostic accuracy of combined CF markers was 73.68 % with a sensitivity of 78.57 %, specificity of 72.58%, PPV of 39.29%, NPV of 93.75% and AUC of 0.675.