Résumé
La découverte d'une lésion kystique du pancréas pose de difficiles problèmes de prise en charge. Le traitement est fonction de la nature bénigne ou maligne du kyste. Les données fournies par l'examen clinique et l'imagerie ne permettent pas un diagnostic préopératoire, même si l'échoendoscopie digestive a un rôle important dans le diagnostic de ces lésions kystiques dont certaines sont potentiellement malignes. L'analyse biochimique du liquide intra-kystique (marqueurs tumoraux et enzymes pancréatiques) a été proposée pour permettre de préciser la nature du kyste. L'aspiration à l'aiguille fine permet un diagnostic fiable uniquement si la ponction et le traitement de l'échantillon suivent rigoureusement un mode opératoire spécifique. Les différents points critiques concernant le prélèvement, la préparation de l'échantillon cellulaire et de la microbiopsie sont étudiés. Une étude combinée cytologique et histologique est recommandéc. Dans ces conditions, il est facile de faire un diagnostic positif de lésions kystiques telles que le cystadénocarcinome mucineux, l'adénocarcinome canalaire nécrotique, le carcinome à cellules acineuses, les tumeurs endocrines et la tumeur solide pseudopapillaire. Il convient ensuite de différencier les tumeurs mucineuses de celles qui ne le sont pas. La cytologie monocouche est utile pour faire le diagnostic des tumeurs paucicellulaires comme le cystadénome séreux; elle permet de compléter l'analyse en autorisant des études immunocytochimiques.
Summary
The discovery of a pancreatic cystic lesion implies a challenge for the physician. The selection of the appropriate treatment depends on the ability to distinguish benign from malignant cysts. The clinical and radiological features of these lesions may not permit a preoperative diagnosis, even if endoscopic ultrasonography has an important role to determine which cystic lesions have malignant potential. Analysis of cyst fluid aspirates for tumor markers and enzymes has been proposed as an aid to differential diagnosis. An accurate diagnosis by fine-needle aspiration (FNA) needs a careful and specific handling and preparation of the sample. Critical issues for preparation of sample, cytological and histological procedures are reviewed. Combined cytology and microbiopsy are recommended. FNA provides easy and definitive diagnosis for mucinous cystadenocarcinoma, necrotic ductal carcinoma, acinar cell carcinoma, endocrine neoplasms and solid pseudopapillary tumor. Then the major role of FNA is to differentiate mucinous from nonmucinous pancreatic cyst. Monolayered smears are useful for paucicellular tumors such as serous cystadenoma and for ancillary techniques such as immunodetection.
Article PDF
Avoid common mistakes on your manuscript.
Références
CENTENO B.A., BISHOP PITMAN M. — Fine-needle aspiration biopsy of the pancreas. Butterworth-Heinemann, 1999.
HORVATH K.D., CHABOT J.A. — An aggressive resectional approach to cystic neoplasms of the pancreas.Am. J. Surg., 1999,178, 269–274.
KIMURA W., MAKUUCHI M. — Operative indications for cystic lesions of the pancreas with malignant potential: our experience.Hepatogastroenterology, 1999,46, 483–491.
HAMMEL P. — Diagnostic value of cyst fluid analysis in cystic lesions of the pancreas: current data, limitations, and perspectives.J. Radiol., 2000,81, 487–490.
BENTZ J.S., KOCHMAN M.L., FAIOEL D.O., GINSBERG G.G., SMITH D.B., GUPTA P.K. — Endoscopic ultrasoundguided real-time fine-needle aspiration: clinicopathogic features of 60 patients.Diagn. Cytopathol., 1998,18, 98–109.
CHANG K.J., NGUYEN P., ERICKSON R.A., DURBIN T.E., KATZ K.D. — The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma.Gastrointest. Endosc., 1997,45, 387–393.
BRANDWEIN S.L., FARRELL J.J., CENTENO B.A., BRUGGE W.R. — Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS.Gastrointest. Endosc., 2001,53, 722–727.
DE CALAN L., LEVARD H., HENNET H., FINGERHUT A. — Pancreatic cystadenoma and cystadenocarcinoma: diagnostic value of preoperative morphological investigations.Eur. J. Surg., 1995,161, 35–40.
CURRY C.A., ENG J., HORTON K.M., URBAN B., SIEGELMAN S., KUSZYK B.S., FISHMAN E.K. — CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment?Am. J. Roentgenol., 2000,175, 99–103.
PROCACCI C., BIASIUTTI C., CARBOGNING G., ACCORDINI S., BICEGO E., GUARISE A., SPOTO E., AANDREIS I.A., DE MARCO R., MEGIBOW A.J. — Characterization of cystic tumors of the pancreas: CT accuracy.J. Comput. Assist. Tomogr., 1999,23, 906–912.
LE BORGNE J., DE CALAN L., PARTENSKY C. — Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association.Ann. Surg., 1999,230, 152–161.
SCHACHTER P.P., AVNI Y., GVIRZ G., ROSEN A., CZERNIAK A. — The impact of laparoscopy and laparoscopic ultrasound on the management of pancreatic cystic lesions.Arch. Surg., 2000,135, 260–264.
LEWANDROWSKI K.B., SOUTHERN J.F., PINS M.R., COMPTON C.C., WARSHAW A.L. — Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma.Ann. Surg., 1993,217, 41–47.
HAMMEL P., VOITOT H., VILGRAIN V., LEVY P., RUSZNIEWSKI P., BERNADES P. — Diagnostic value of CA 72-4 and carcinoembryonic antigen determination in the fluid of pancreatic cystic lesions.Eur. J. Gastroenterol. Hepatol., 1998,10, 345–348.
WILLIAMS D.B., SAHAI A.V., AABAKKEN L., PENMAN I.D., VAN VELSE A., WEBB J., WILSON M., HOFFMAN B.J., HAWES R.H. — Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.Gut, 1999, 44, 720–726.
DAVID O., GREEN L., REDDY V., KLUSKENS L., BITTERMAN P., ATTAL H., PRINZ R., GATTUSO P. — Pancreatic masses: a multi-institutional study of 364 fine-needle aspiration biopsies with histopathologic correlation.Diagn. Cytopathol., 1998,19, 423–427.
SPERTI C., PASQUALI C., GUOLO P., POLVEROSI R., LIESSI G., PEDRAZZOLI S. — Serum tumor markers and cyst fluid analysis are useful for the diagnosis of pancreatic cystic tumors.Cancer, 1996,78, 237–243.
NGUYEN G.K., SUEN K.C., VILLANUEVA R.R. — Needle aspiration cytology of pancreatic cystic lesions.Diagn. Cytopathol., 1997,17, 177–182.
DI STASI M., LENCIONI R., SOLMI L., MAGNOLFI F., CATURELLI E., DE SIO I., SALMI A., BUSCARINI L. — Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study.Am. J. Gastroenterol., 1998,93, 1329–1333.
CENTENO B.A., WARSHAW A.L., MAYO-SMITH W., SOUTHERN J.F., LEWANDROWSKI K. — Cytologic diagnosis of pancreatic cystic lesions. A prospective study of 28 percutaneous aspirates.Acta Cytol., 1997,41, 972–980.
CENTENO B.A. — Fine-needle aspiration biopsy of the pancreas.Clin. Lab. Med., 1998,18, 401–427.
FABRE M., COCHAND-PRIOLLET B. — Diagnosis of pancreatic lesions by fine needle aspiration: present status and pitfalls.Ann. Pathol., 1999,19, 429–438.
FABRE M., LABADIE M. — Rapid staining and guided fine needle aspiration for deep masses.Clin. Exp. Pathol., 1999,47, 297–302.
LJUNG B.M., DREJET A., CHIAMPI N., JEFFREY J., GOODSON W.H. 3rd CHEW K., MOORE D.H. 2nd, MILLER T.R. — Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique.Cancer, 2001,93, 263–268.
WIERSEMA M.J., VILMANN P., GIOVANNINI M., CHANG K.J., WIERSEMA L.M. — Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.Gastroenterology, 1997,112, 1087–1095.
AFFI A., VAZQUEZ-SEQUEIROS E., NORTON I.D., CLAIN J.E., WIERSEMA M.J. — Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance.Gastrointest. Endosc., 2001,53, 221–225.
O'TOOLE D., PALAZZO L., AROTCARENA R., DANCOUR A., AUBERT A., HAMMEL P., AMARIS J., RUSZNIEWSKI P. — Assessment of complications of EUS-guided fine-needle aspiration.Gastrointest. Endosc., 2001,53, 470–474.
FABRE M., MONGES G., BEN LAGHA N., GIOVANNINI M., DANCOUR A., AMOUYAL P., PATRIARCHE C., BERNARDINI B., ROCHER L., NEIDHART R., PAUZE J.L., AMOUYAL G. — Paired comparison of conventional and ThinPrep fine needle aspiration (FNA) biopsy. A prospective series of 42 deep masses.Clin. Exp. Pathol., 1998,46, 238.
AKOSA A.B., DESA L.A., PHILLIPS I., BENJAMIN I.S., POLAK J.M., KRAUSZ T. — Aspiration cytodiagnosis of pancreatic endocrine tumors.Cytopathology, 1994,5, 369–379.
COLLINS B.T., CRAMER H.M. — Fine-needle aspiration cytology of islet-cell tumors.Diagn. Cytopathol., 1996,15, 37–45.
SHAW J.A., VANCE R.P., GEISUNGER K.R., MARSHALL R.B. — Islet cell neoplasms. A fine-needle aspiration cytology study with immunocytochemical corelations.Am. J. Clin. Pathol., 1990,94 142–149.
KASHIMA K., HAYASHIDA Y., YOKOYAMA S., NAGAHAMA J., SATO K., DAA T., GAMACHI A., NAKAYAMA I. — Cytologic features of solid and cystic tumor of the pancreas.Acta Cytol., 1997,41, 443–439.
PELOSI G., IANNUCI A., ZAMBONI G., BRESAOLA E., NACONO C., SERIO G. — Solid and cystic papillary neoplasm of the pancreas: a clinico-cytopathologic and immunocytochemical study of five new cases diagnosed by fine-needle aspiration cytology and a review of the literature.Diagn. Cytopathol., 1995,13, 233–246.
MANDREKAR S.R., PINTO R.G., PATIL R., VERNEKAR J., PALYEKAR S., NADKARNI N. — Solid and papillary epithelial neoplasm of the pancreas. Report of a case with diagnosis by fine needle aspiration cytology.Acta Cytol., 1997,41, 1823–1827.
CRAWFORT B.E. — Solid and papillary epithelial neoplasm of the pancreas. Diagnosis by cytology.South. Med. J., 1998,91, 973–977.
LABATE A.M., KLIMSTRA D.L., ZAKOWSKI M.F. — Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumor.Diagn. Cytopathol., 1997,16, 112–116.
SAMUEL L.H., FRIERSON H.F. Jr. — Fine needle aspiration of acinar cell carcinoma of the pancreas: a report of two cases.Acta Cytol., 1996,40, 585–591.
YAMAGUCHI K., TANAKA M. — Atlas of cystic neoplasms of the pancreas. Kyushu University Press. Karger, 2001.
CARLSON S.K., JOHNSON C.D., BRANDT K.R., BATTS K.P., SALOMAO D.R. — Pancreatic cystic neoplasms: the role and sensitivity of needle aspiration and biopsy.Abdom. Imaging., 1998,23, 387–393.
IWAO T., TSUCHIDA A., HANADA K., EGUCHI N., KAJIYAMA G., SHIMAMOTO F. — Immunocytochemical detection of p53 protein as an adjunct in cytologic diagnosis from pancretic duct brushings in mucin-producing tumors of the pancreas.Cancer, 1997,81, 163–171.
MONGES G.M., MATHOULIN-PORTIER M.P., ACRES R.B., HOUVENAEGHEL G.F., GIOVANNINI M.F., SEITZ J.F., BARDOU V.J., PAYAN M.J., OLIVE D. — Differential MUC 1 expression in normal and neoplastic human pancreatic tissue. An immunohistochemical study of 60 samples.Am. J. Clin. Pathol., 1999,112, 635–640.
PINTO M.M., EMANUEL J.R., CHATURVERDI V., COSTA J. —Ki-ras mutations and the carcinoembryonic antigen level in fine needle aspirates of the pancreas.Acta Cytol., 1997,41, 427–434.
FUKUSHIMA N., SUZUKI M., FUKAYAMA M. — Analysis ofKi-ras oncogene mutation directly applied to atypical cell clusters on cytological smear of bile and pancreatic juice.Pathol. Int., 1998,48, 33–40.
YEH T.S., CHENG A.J., CHEN T.C., JAN Y.Y., HWANG T.L., JENG L.B., CHEN M.F., WANG T.C. — Telomerase activity is a useful marker to distinguish malignant pancreatic cystic tumors from benign neoplasms and pseudocysts.J. Surg. Res., 1999,87, 171–177.
INOUE H., TSUCHIDA A., KAWASAKI Y., FUJIMOTO Y., YAMASAKI S., KAJIYAMA G. — Preoperative diagnosis of intraductal papillary-mucinous tumors of the pancreas with attention to telomerase activity.Cancer, 2001,91, 35–41.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Fabre, M. Diagnostic des lésions kystiques du pancréas par l'aspiration à l'aiguille fine guidée sous échoendoscopie digestive Quel prélèvement et pourquoi? Utilité de la microbiopsie sur la paroi du kyste et de l'analyse du liquide en technique monocouche. Acta Endosc 32, 71–83 (2002). https://doi.org/10.1007/BF03018032
Issue Date:
DOI: https://doi.org/10.1007/BF03018032
Mots-clés
- aspiration à l'aiguille fine
- biopsie
- carcinome
- cystadénome
- cytologie
- échoendoscopie digestive
- pancréas
- ThinPrep
- tumeur
- endocrine
- tumeur kystique
- tumeur solide pseudopapillaire