The Role Of Endoscopic Ultrasonography, Magnetic Resonance İmaging And Computed Tomography İn The Diagnostic Evaluation Of Pancreatic Cystic Lesions

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2020

Thesis Language: Turkish




In this study, it has been aimed to reveale the 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 and malignancy rates. As being a single-center retrospective study, 138 patients aged between 19 and 85 years has been researched by thereof. Within the context of the study, CT, MRI, EUS and pathology reports of the related patients were scrutinised. The age of the patients, presence of concomitant diabetes mellitus, final diagnosis reported in each method, pancreatic cyst localization of patients, pancreatic cyst size, presence of lymphadenopathy, pancreatic duct width and biochemical markers in cyst fluid aspiration were recorded for all scrutinised reports. Descriptive statistical methods were used to cover all features of the pancreatic cysts. Continuous data were summarized in the form of mean ± standard deviation and median (minimum-maximum), while the categorical data were summarized with frequencies and percentages. Non-parametric test is utilised for the non-normally distributed continuous variables where the p <0.005 accepted as having a significant value. . Sensitivity and selectivity values of CT, MRI and EUS with their respective 95% confidence intervals were calculated by taking the postoperative histopathology results as the gold standard. The average age of our patients is calculated as 59.30 ± 13.06 years. Analysing the data of 138 patients including n=81 women (58.7%) and n=57 men (41.3%) diagnosed with pancreatic cyst, the highest sensitivity, specificity and diagnostic accuracy rates in the neoplastic-non-neoplastic distinction of pancreatic cystic lesions was detected in CT. EUS had similar sensitivity and diagnostic accuracy rates as CT, whereas its specificity was considered to be lower than CT. On the other hand, MRI had lower sensitivity, specificity and diagnostic accuracy rates compared to both tests. Although the level of sensitivity of EUS in detecting mucinous lesions was higher than the other two, the sensitivity value (p> 0.005) could not be accepted as statistically significant. The sensitivity, specificity and diagnostic accuracy rate of EUS guided FNA biopsies were very low. In the study, no significant relationship has been confirmed between the size of pancreatic cysts and malignancy (p> 0.005). Besides, no significant relationship has been detected between the presence of peripancreatic lymphadenopathy and malignancy (p> 0.005). However, amylase level was found to be significantly high in non-neoplastic cystic lesions (p <0.005). CT and EUS correlated well with each other in terms of overall diagnostic compliance whereas a moderate level of correlation was found between MRI and EUS. Today, having the reality of observing an increasing number of pancreatic cyst cases, as a result of frequent use of abdominal screening methods, and the malignancy potential of the relevant cases, makes it crucial to make an accurate diagnosis for the treatment and follow-up plan of these patients. For this reason, it has been evaluated that the rational use of imaging methods and working with an on-site cytopathologist to ensure that sufficient diagnostic material is obtained, especially in EUS guided fine needle aspiration biopsies will create a significant increase in the diagnostic accuracy rates. Keywords: Pancreatic cystic lesion, pancreatic cystic neoplasms, IPMN, EUS, MR, CT, sensitivity, specificity, diagnostic accuracy rate.