EFFECTIVENESS OF AGA, FUKUOKA AND EUROPEAN GUIDELINES IN THE MANAGEMENT OF INCIDENTALOMAS OF THE PANCREAS ANALYZED PRIOR TO PERFORMING ENDOSCOPIC ULTRASOUND WITH FINE NEEDLE PUNCTURE

Abstract

Introduction: International consensus guidelines are commonly used to identify patients at high risk of developing cancer or with cancer. Its applicability, however, is based on investigation through imaging tests, however without histological confirmation. Objective: To compare the performance and results of international guidelines in incidental mucinous neoplasia after diagnosis obtained by endoscopic ultrasound-guided fine needle puncture (EUS-PAF). Methods: Single-center study with prospective collection of data from asymptomatic patients with the disease who underwent EUS-PAF. Appropriate cohort selection included images that were ambiguous regarding this diagnosis or the presence and/or development of other worrisome features as defined by international guidelines. After microhistological analysis of the material obtained, each of the guideline criteria was applied to identify cancer among patients with the disease. Results: 251 patients had the diagnosis confirmed by EUS-PAF or surgical procedure. The majority were asymptomatic. The final diagnosis revealed 27.8% (n=39) with malignant disease or high-risk signs. After applying the AGA-2015, IAP-2017 and DE-2018 criteria, it was observed that those detected incidentally were referred for surgery unnecessarily. These guidelines did not identify malignant and high-risk disease in 59%, 33.3% and 46.1%, respectively. Conclusion: The European DE-2018 proved to be more accurate for use in patients with asymptomatic incidental mucinous neoplasia after the diagnosis obtained by EUS-PAF.