Endoscopic Ultrasound Identifies Synchronous Pancreas Cystic Lesions Not Seen on Initial Cross-Sectional Imaging

Objectives: A retrospective review conducted to determine the utility of endoscopic ultrasound (EUS) examination of the pancreas after initial pancreatic cyst detection with cross-sectional imaging. Methods: A retrospective review of 145 patients referred for EUS for evaluation of pancreas cystic lesions. Initial cross-sectional imaging reports were reviewed and compared to subsequent EUS findings. Findings evaluated included cyst size, number, multifocality, presence in different surgical fields, cyst wall nodularity, main pancreatic duct (PD) dilation, communication with PD, and features suggestive of serous cystadenoma. Results: Compared to computed tomographic scan, EUS more frequently identified pancreatic cystic lesion multifocality (47% vs 13%, P < 0.0001) and their presence in different surgical fields (33.3% vs 4.2%, P < 0.0001). Compared to magnetic resonance imaging, EUS was superior in identifying multifocality (58% vs 34%, P = 0.0002) and the presence of cysts in different surgical fields (42% vs. 26%, P = 0.021). Malignancy was suspected or confirmed in 3 patients by EUS fine-needle aspiration cytology, not suspected by cross-sectional imaging. Endoscopic ultrasound identified unappreciated features of serous cystadenomas in 10 patients. Conclusion: Endoscopic ultrasound identified synchronous pancreatic cystic lesions unappreciated by initial cross-sectional imaging, with undetected cysts frequently outside of typical resection margins. In addition, EUS identified the presence of unappreciated high-or low-risk characteristics in a small percentage of patients.