EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in resected cases.

BACKGROUND: Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. METHODS: The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. RESULTS: Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). CONCLUSIONS: EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma.

Improved survival after non-traumatic subarachnoid haemorrhage with structured care pathways and modern intensive care.

OBJECTIVE: Patients with subarachnoid haemorrhage (SAH) often require multidisciplinary management and their treatment is difficult to standardize. The aim was to describe baseline characteristics, care pathways and discharge status in an unselected group of patients with first ever non-traumatic SAH, and to examine whether their care pathways and outcomes vary. METHODS: Patients admitted with first ever non-traumatic SAH to a neurosurgical unit (NSU) in Sweden during a period of 18 months in 2009-2010 were included. The data was retrospectively collected from patient charts. RESULTS: A total of 131 patients were admitted with first ever non-traumatic SAH. Forty-nine (37%) patients initially sought medical care nearby the NSU and 82 (63%) in other parts of the catchment area. The average age was 55.5 years and 79 (60%) were female. In 98 (75%) cases, a ruptured aneurysm was found to be the cause of SAH. There was a significant correlation between poor clinical grade at admission and poor patient outcome (p<0.0005). No significant correlation between early aneurysm treatment and improved clinical outcome were seen. No significant differences in outcome were seen between patients who initially sought medical care nearby the NSU and those in other parts of the catchment area. There was no difference seen in the number of patients who had follow-up at the NSU depending on where they initially sought help. CONCLUSION: This study shows an improvement in survival after SAH compared to earlier studies in Sweden. The results are indicative of effective management of all patients with SAH in the catchment area that are treated at the NSU. A nationwide registry to assess the overall management of patients treated for SAH would be useful to further investigate patients with SAH.