New Technique Looks Inside Pancreatic Cysts To Help Determine If Surgery Is Necessary

COLUMBUS, Ohio (KDKA) – Mike Richter has had three bouts with cancer: lymphoma, prostate and the most recent one — pancreatic.

The doctors found it on CT scans while following his other cancers.

“I went in and they said, yeah, your lymphoma is doing okay. We’ve been following this pancreatic cyst. They’d been following…I didn’t know…for like a year or two,” Mike says. “It got bigger and bigger. No symptoms.”

He had a new kind of test to look inside the cyst. There the doctors saw the cells were progressing toward cancer. Mike had an operation to remove his pancreas.

“He was showing me the geography of the pancreas, what all he was going to take. It was attached to my spleen. So he had to take the spleen, too,” Mike continues. “The operation was difficult.”

What if you could spare someone like Mike a big, complicated surgery?

“What’s not talked about is prevention of unnecessary surgery,” says Dr. Somashekar Krishna, a gastroenterologist at the Ohio State Wexner Medical Center. “Nearly 30 to 40 percent of pancreatic surgeries are performed on lesions which are potentially benign, or are not that close to progressing to pancreatic cancer.”

That’s the idea behind the new test he had.

The doctors at Ohio State University have trained doctors at eight other university hospitals — with plans to train at four more centers — this new technique, looking at the inside of the cyst. A procedure called endomicroscopy.

Typically fluid is taken from the cyst to be checked for cancer. But the accuracy of that test is about 65 percent. A third of patients will be told all is clear and will actually have cancer — or, they’ll be told they have cancer, but after the big operation, find out everything was benign.

That’s where endomicroscopy comes in. The doctors can see inside the cyst, a fluid-filled sac, and check the appearance of the cells lining the sac. If the cells looks like they are about to turn cancerous, the pancreas comes out.

“So there is an opportunity to intervene, and remove the cyst before they can turn cancerous,” says Dr. Krishna.

By adding endomicroscopy to the fluid test, accuracy increases to 97 percent. And that can spare people with benign cysts the removal of their pancreas, which can come with digestive problems and diabetes afterwards.

“And now, our next job is to replicate this across multiple centers across the country,” Dr. Krishna says.

Endomicroscopy is covered by insurance, but it’s only available at a few centers where doctors have been trained.

You can’t get this test if you’re allergic to certain dyes, or if you have a solid lump in your pancreas. Some people can get inflammation of the pancreas after the procedure.

Getting an answer with more certainty makes Mike feel better about having his pancreas out.

“I was relieved,” he says, “It felt very good to get out. I’m doing really well. It concerns me the chance for diabetes.”

He watches his diet and blood sugar, and he gets scans and bloodwork to monitor for any return of his cancers.