| Abstract | Cistični tumori gušterače su epitelom omeđene tvorbe ispunjene tekućim sadržajem, a ovisno o vrsti epitela mogu imati benigni ili maligni potencijal. Smatra se da 1,2% populacije ima cistične lezije unutar parenhima gušterače od kojih 60% čine cistični tumori dok su ostatak pseudociste, kongenitalne i izvanpankreasne ciste te cistično degenerirani solidni tumori. Od svih tumora gušterače, cistični tumori su zastupljeni u 10-15% slučajeva. Na cistične tumore gušterače se najčešće posumnja na temelju slučajnog nalaza transabdominalnog ultrazvuka, CT-a ili MR-a koji se rade u sklopu obrade različitih bolesti probavnog sustava. Najčešći tip cističnih tumora je mucinozna cistična neoplazma koja je prisutna u 45% slučajeva, predominantno u mladih žena, te ima tendenciju maligne alteracije u 25% bolesnika. Nešto rjeđi tipovi cističnih tumora su: serozni cistadenom, intraduktalna papilarna mucinozna neoplazma, solitarna pseudopapilarna neoplazma i neuroendokrini tumori gušterače. Najosjetljivija dijagnostička metoda i zlatni standard u postavljanju dijagnoze malignih i benignih lezija gušterače je endoskopski ultrazvuk (EUZ). Osim mogućnosti detaljne vizualizacije, EUZ pruža i mogućnost uzimanja uzorka uz pomoć metode nazvane tankoiglena aspiracija pod kontrolom EUZ-a. EUZ-om se može prikazati cjelokupna struktura parenhima gušterače, ukupna veličina, lokalizacija i broj cista, komunikacija s glavnim ili postraničnim vodom, debljina stijenke, intracistične tvorbe poput septi, solidnih dijelova ili kalcifikata što sve pruža korisne informacije u procjeni malignog potencijala analizirane lezije. U vremenskom periodu od 2009. do 2018. godine na Zavodu za gastroenterologiju i hepatologiju KBC Sestre milosrdnice učinjeno je 5014 pregleda EUZ-om, a u 239 bolesnika je detektirano postojanje cističnog tumora gušterače. Cilj istraživanja je bio utvrditi dijagnostičku preciznost EUZ-a u dijagnostici i praćenju bolesnika s cističnim tumorima gušterače, te osjetljivost i specifičnost EUZ-FNA. Rezultati analize upućuju da dijagnostička preciznost EUZ-a iznosi 93.2%. Osjetljivost za detekciju malignog tumora iznosi 100%, a specifičnost 75.7%. |
| Abstract (english) | Pancreatic cystic tumors are epithelium-bound formations filled with cystic content, and depending on the type of epithelium, can have a benign or malignant potential. 1,2% of population has cystic lesions within pancreatic parenchyma, of which 60% constitute cystic tumors. The rest are pseudocysts, congenital and non-pancreatic cysts, and cystically degenerate solid tumors. Cystic tumors are represented in 10-15% of cases and can be assessed with multiple imaging modalities, including transabdominal ultrasound, CT, MRI, EUS. They are usually accidentally diagnosed as part of the diagnosis of some other gastrointestinal diseases. The most common type of cystic tumor is mucinous cystic neoplasia which is present in 45% of cases, predominantly in young women, and has a tendency of malignant alteration in 25% of patients. Some rarer types of cystic tumors include: serous cysadenoma, intraductal papillary mucinous neoplasms, solitary pseudopapillar neoplasms and neuroendocrine pancreatic tumors. The most sensitive diagnostic method and the gold standard for malignant and benign lesions of the pancreas is endoscopic ultrasound. In addition to the possibility of visualization, the EUS provides the possibility of additional diagnostic procedure used to collect the sample of cystic cells which is called endoscopic ultrasound guided fine-needle aspiration. The EUS can show the overall structure of the pancreas parenchyma, the total size, the localization and the number of cysts, the communication with the main or branch duct, thickness of the wall, septa, intracystic solid parts and all of it provides useful informations in evaluating the malignancy of the analyzed lesion. In the period from 2009 to 2018, 5014 EUS procedures were performed at the Department of Gastroenterology and Hepatology, University Hospital Centre “Sestre milosrdnice”. In 239 participants was detected the existence of cystic pancreatic tumors. The aim of this study was to determine the diagnostic precision of the EUS in the diagnosis and monitoring of patients with pancreatic cystic tumors, and to investigate the sensitivity and and specificity of EUS-FNA. The results showed that the diagnostic precision of the EUS was 93,2% whereas the sensitivity of malignant tumor detection was 100% and specificity 75,7%. |
