Partial Atrophy of The Pancreas in Endoscopic Ultrasonography may be a Sign of Pancreatic Cancer

Introduction: Solid and/or cystic lesions of the pancreas can range from benign to malignant, and the differential diagnosis of pancreatic carcinoma (PC) is of uttermost importance. Endoscopic ultrasonography (EUS) is frequently used and is helpful in detecting small (<2 cm) lesions and provides information about the extralesional pancreas. EUS also facilitates tissue diagnosis and allows the cyst fluid examination. Our aim was to evaluate the role of EUS findings and cyst characteristics of pancreatic lesions in predicting PC. Methods: Records of patients with pancreatic lesions were retrospectively assessed. EUS findings, serum C19-9 levels, CEA levels, and cyst biochemistry of the patients were noted. The relationship between PC, mucinous pathologies, EUS findings, cyst characteristics, and serum biochemistry was evaluated. Results: Two-hundred-four patients had EUS-guided biopsy for a pancreatic lesion (48% solid). Eighty-nine patients had PC. The serum CA19-9 cut-off value for PC was 37 U/mL (AUC: 0.81). In multivariate analysis, solid lesions, age, CA19-9>37 U/mL, and partial atrophy in the pancreas were independently associated with PC. For solid lesions, age and size >24 mm; and for cystic lesions, male gender and mucinous pathology were independently associated with PC. Thirty-six of the cystic lesions had mucinous pathology. Cyst and serum CEA, string sign, wesung connection, and tail location was associated with mucinous pathology. Cyst CEA cut-off for mucinous pathology was 80 ng/mL (AUC: 0.89). CEA >80 ng/mL was found to be associated with mucinous pathology in multivariate analysis. Conclusion: High CA19-9, solid lesion, and lesion-related partial atrophy of the pancreas are associated with PC, and these should be alarming for clinicians in practice. The mucinous character, which is a significant risk of PC for cystic lesions, can be optimally defined with the CEA cut-off value of 80 ng/mL.