B0003 - Differential Diagnosis and Management of Subcentimeter Solid Pancreatic Lesions

Fredy Nehme, MD, MS¹, Abraham Yu, MD², Faisal Ali, MD², Cynthia Liu, MD¹, Emmanuel Coronel, MD¹, Brian Weston, MD¹, William Ross, MD¹, Phillip Ge, MD¹, Phillip Lum, ¹, Daniel Low, MD¹, Jeffrey H. Lee, MD, MPH^1
1University of Texas MD Anderson Cancer Center, Houston, TX; ²University of Texas Health Science Center, Houston, TX

Introduction: Improved imaging techniques allow the detection of small pancreatic solid lesions, with lesions as small as 4 mm can be detected by EUS. Given the risk of malignancy of these lesions, evaluation by EUS-guided fine needle aspiration (EUS-FNA) is commonly warranted. The differential diagnosis of lesions ≤ 1 cm detected on EUS has not been thoroughly elucidated, and guidance on the appropriate management strategy remains limited. The aim of this study is to determine the etiology of small pancreatic solid lesions ≤ 1 cm in maximal diameter to optimize clinical management.

Methods: Over a period of 10 years, patients with pancreatic solid lesions ≤ 1 cm in size detected on EUS with a definite histologic or cytologic diagnosis were retrospectively evaluated. Cystic or semisolid lesions were excluded. Indication, EUS characteristics, and further management was evaluated.

Results: A total of 118 patients with solid pancreatic lesions ≤ 1 cm on EUS were included in our analysis. The median age was 59 years (48-66) and 55.1% were females. 79.6% of patients were referred for an EUS for an incidental nodule detected on cross-sectional imaging. The median lesion size was 8 mm (range 3.8-10 mm), and most common location was pancreatic tail (34.7%). Endosonographically, most lesions were described as hypoechoic, and 66.9% as regular. Nearly half of the patients had more than one pancreatic lesion on EUS. On cytology obtained by FNA, 65.3% were neuroendocrine tumors, 11.9% were metastatic, and 4.2% showed pancreatic adenocarcinoma (PDAC). Renal cell carcinoma was the most common metastatic lesion in 64.3% of the cases. The median number of passes obtained by EUS-FNA was 2.

Most patients were managed conservatively with repeat cross-sectional imaging 49.2% of the cases and repeat EUS 13.6% of the time. 18.6% underwent surgical resection while 7.6% had systemic chemotherapy or radiation. 1 and 2-year survival were 94.9% and 86% respectively. There was no significant difference in 2-year survival according to the etiology.

Discussion: This retrospective study shows the etiologic variability of subcentimeter pancreatic solid lesions discovered on EUS. Only a minority of patients were diagnosed with pancreatic adenocarcinoma. EUS-FNA can provide useful adjunctive information to optimize management strategies. Accurate characterization of small solid pancreatic lesions without delay is crucial and could avoid morbidity associated with pancreatic surgery by reliable diagnosis of non-pancreatic adenocarcinoma.


Disclosures:


Fredy Nehme, MD, MS¹, Abraham Yu, MD², Faisal Ali, MD², Cynthia Liu, MD¹, Emmanuel Coronel, MD¹, Brian Weston, MD¹, William Ross, MD¹, Phillip Ge, MD¹, Phillip Lum, ¹, Daniel Low, MD¹, Jeffrey H. Lee, MD, MPH¹. B0003 - Differential Diagnosis and Management of Subcentimeter Solid Pancreatic Lesions, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.