胰腺囊性肿瘤的定性诊断

目的 探讨胰腺囊性肿瘤病人术前症状、实验室检查、影像学特征及针吸活检在判断病变良恶性及对外科治疗的指导作用.方法 回顾性分析北京大学第一医院1994-2008年手术治疗的69例胰腺囊性肿瘤病人的临床资料,对性别、症状与体征、肿瘤部位、大小、肿瘤标记物、肿瘤实性成分、有否钙化及胰管梗阻等可能预测肿瘤恶性行为的风险因素进行统计学分析.结果 经术后病理证实,69例病人包括浆液性肿瘤13例,黏液性囊性肿瘤30例,胰管内乳头状黏液性肿瘤7例,实性假乳头状瘤12例,囊性内分泌肿瘤及其它肿瘤7例.69例中交界性或恶性44例,良性25例.单因素分析病人术前上述指标,显示梗阻性黄疸、血清CA19-9或CEA水平、肿瘤直径大于5 cm、囊性肿瘤实性成分与恶性病理关系密切,敏感性分别为34.1%(15/44)、47.7%(21/44)、88.6%(39/44)和72.7%(32/44),特异性为96%(24/25)、84%(23/25)、68%(17/25)和72%(18/25);多因素分析发现后三者为预测胰腺恶性囊性肿瘤的独立危险因素.9例病人行穿刺细胞学及囊内容物检查淀粉酶及CEA/CA19-9,其中3例明确恶性诊断.33例行术中冰冻病理,其中1例胰腺导管内乳头状黏液性癌切缘阳性改行全胰切除术.结论 综合评估术前无创检查资料,多能判断胰腺囊性肿瘤的良恶性进而指导临床治疗,术前穿刺活检适于良性可能性大并拟随诊观察者;术中行切缘病理检查可指导手术切除范围.     

无症状性胰腺囊性肿瘤的临床及病理特征分析

目的 探讨及分析无症状性胰腺囊性肿瘤的临床及病理特征。方法 回顾性分析北京协和医院1984年1月至2008年6月126例经手术治疗的胰腺囊性肿瘤的病例资料。结果 126例胰腺囊性肿瘤的病人中,60例无症状,其中56例为良性,28例为浆液性囊腺瘤,25例为黏液性囊腺瘤,3例为导管内乳头状黏液性肿瘤;4例为恶性,3例为黏液性囊腺癌,1例为侵袭性导管内黏液性肿瘤。 采用单因素和多因素变量分析结果显示病人的性别,肿瘤大小和影像学特征性表现（包括实性成分和主胰管扩展）在胰腺良、恶性囊性肿瘤之间差异有统计学意义,男性在恶性肿瘤中显著多于女性（P=0.01）; 影像学特征性表现是常常是判断肿瘤恶性可能的独立因素。对于直径<3cm的肿瘤,无症状的胰腺囊性肿瘤更多见于良性肿瘤。结论 在无症状胰腺囊性肿瘤中,恶性肿瘤发病率比较低,尤其对于肿瘤直径<3cm的无症状囊性肿瘤,如果影像学检查显示囊肿内无实性成分或乳头状突起,胰管不扩张者,可采用保守观察的方法,定期随访。     

恶性胰腺囊性肿瘤的临床相关因素分析

目的 探讨恶性胰腺囊性肿瘤的临床相关因素.方法 回顾性分析2000年5月至2011年5月天津医科大学总医院收治的45例经手术治疗的胰腺囊性肿瘤患者的临床资料,根据病理检查结果分为良性肿瘤+癌前病变组(35例)和恶性肿瘤组(10例),分析胰腺囊性肿瘤的临床症状和影像学特征,以及与恶性胰腺囊性肿瘤的相关性.单因素分析采用x2检验,多因素分析采用Logistic回归模型.结果 本组中51％ (23/45)的患者有临床症状,包括腹痛、黄疸、消瘦、恶心呕吐等,49％(22/45)的患者无临床症状,为其他原因就诊时发现.良性胰腺囊肿在影像学检查中的特征为胰腺钙化和分隔;恶性胰腺囊性肿瘤的特征为肿瘤结节、淋巴结肿大、胆管扩张、胰管扩张等.单因素分析结果显示:患者年龄、有无临床症状、黄疸、消瘦、胰管扩张与恶性肿瘤密切相关(x2=4.220,4.294,4.645,7.705,4.645,P＜0.05);多因素分析结果显示:年龄≥60岁、胰管扩张和有临床症状与恶性肿瘤具有显著的相关性,其相关性依次逐渐增高( OR=1.573,2.674,2.723,P＜0.05).结论 年龄≥60岁、胰管扩张和有临床症状是恶性胰腺囊性肿瘤的危险因素.     

女性盆腔囊实性病变的CT诊断

目的:探讨女性盆腔囊实性病变的螺旋CT表现,提高定性诊断能力。方法:回顾性分析经手术或穿刺病理证实女性盆腔囊实性病变的CT及MR资料,探讨其影像学特征。结果:76例盆腔囊实性病变中良性病变26例,恶性50例;起源于卵巢的病变56例,起源于输卵管及其系膜的12例,起源于腹腔和盆腔脏器等其它区域的病变8例。囊实性病变CT平扫表现为高低不一的混杂密度,增强后实性部分及分隔不均匀强化,囊内液性部分无强化。MR表现为单房或多房囊实性以囊性为主肿块,T1WI上呈低信号或混杂信号,T2WI上呈高信号。结论:盆腔囊实性病变的影像学表现多种多样,各种不同组织来源的病变各有其特点,分析其影像学特征,初步判断肿瘤的良恶性,确定病变部分性质、侵犯范围和转移,作出准确的定位和定性诊断。     

胰腺囊性肿瘤术前良恶性判断

随着影像诊断技术的广泛应用和改进,胰腺囊性肿瘤（PCN）的诊断率不断增加。常见的胰腺囊性肿瘤包括浆液性囊腺瘤（SCN）、黏液性囊腺瘤（MCN）和导管内乳头状黏液性肿瘤（IPMN）以及囊实性假乳头状肿瘤（SPN）,一旦怀疑为恶性时,均应行根治性手术切除。PCN的术前诊断和良恶性判断十分重要,目前主要依靠临床表现、影像学检查和实验室检查。当临床发现老年男性病人、血清肿瘤标记物CA19-9升高、伴有巨大胰腺肿块、体重下降、有特征性影像学表现者,应考虑恶性肿瘤的可能。主要依靠术后病理、经超声内镜下囊液抽取分析和穿刺组织活检确诊,包括肿瘤相关DNA、MicroRNA和蛋白质标记物的分析。     

胰腺囊性肿瘤的外科治疗

胰腺囊性肿瘤主要包括4种类型,浆液性囊腺瘤(serous cystic neoplasm,SCN),黏液性囊腺瘤(mucinous cystic neoplasm,MCN),导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMN)和实性假乳头状瘤(solid pesudopaplillary tumors,SpT)[1].本文回顾天津医科大学附属肿瘤医院1996年至2010年间收治的经病理证实的胰腺囊性肿瘤病例18例,对其诊断及手术方式进行分析.临床资料1.一般资料:本组18例年龄27～72岁,平均54.8岁.男5例,女13例.7例患者无任何临床症状,于常规查体时发现胰腺占位性病变;11例有症状的患者中,上腹不适4例,腹痛3例,腹部包块2例,黄疸2例.2.辅助检查:1例囊腺癌患者CEA和CA199升高,但不超过正常值2倍.其余患者血清CEA及CA199水平均在正常范围内.全部患者B超检查均提示上腹部低回声囊性或囊实性占位,9例显示囊内有分隔或多囊,内壁光滑,5例显示实性肿物突入囊腔.     

超声内镜对胰腺囊性肿瘤的诊断与治疗的应用进展

随着对胰腺囊性肿瘤认识的提高及影像学诊断仪器的普及,该病的检出率显著提高。由于胰腺囊性肿瘤种类繁多,病理分级可为良性、低度恶性及恶性,而且随着肿瘤体积的增大,病理分级也会不断改变。良性病变的准确诊断对于确定手术方式或内镜治疗的监测需求,以及避免对无潜在恶性的囊肿进行不必要的手术显得尤为重要。近年来,超声内镜(EUS)在胰腺囊性肿瘤的诊断及治疗方面取得了很大进展,本文综述了超声内镜对胰腺囊性肿瘤的诊断与治疗进展。     

非功能性胰腺囊性神经内分泌肿瘤(英)

近十年来非功能性和功能性实质性以及功能性囊性神经内分泌胰腺肿瘤的报告逐见增多，非功能性实质胰岛细胞瘤可类似外分泌胰腺恶性肿瘤．而功能性囊性神经内分泌脑腺肿瘤又易误为良性胰腺囊性疾病，由于各种胰腺良恶性胰腺病变的处理和预后不尽相同．故正确鉴别是必要的。作者报告良、恶性非功能性胰腺馒性肿瘤各1例以及恶性实质性功能性神经     

胰腺囊性肿瘤的研究进展

胰腺囊性肿瘤也称为囊性胰腺肿瘤,约占胰腺肿瘤的5%[1]。随着对其认识的提高和影像学检查发现的增多,在过去10年里,受到了前所未有的关注。胰腺囊性肿瘤在病变性质上可分为良性、交界性和恶性。1996年,世界卫生组织(WHO)根据肿瘤形态及上皮细胞的特征,将胰腺囊性肿瘤     

胰腺囊性肿瘤诊断进展及评价

随着多个学科快速发展和诊断技术不断进步,胰腺囊性肿瘤的检出率明显增加。不同的病变类型其恶变风险不同,尤其对于恶变风险较低的肿瘤,应注意严格把握手术指征。胰腺囊性肿瘤的良恶性鉴别及手术适应证的选择已成为近年来研究的热点。目前,胰腺囊性肿瘤的诊断主要依靠影像学检查,而传统的影像学检查手段（CT、MRI等）尚无法准确区分肿瘤的类型和良恶性。因此,近年来涌现了一系列新技术和新方法用于评估肿瘤类型和鉴别良恶性,如激光共聚焦显微内镜、超声内镜下超声造影和胆道子母镜光纤系统、正电子发射断层显像、纹理分析技术及碎片分析技术、基因突变检测,为指导胰腺囊性肿瘤的诊断和治疗提供了依据。然而,新技术、新方法在诊断灵敏度和特异度方面尚存争议,仍须联合多学科多中心开展进一步研究证实其有效性和安全性。     

How useful are clinical, biochemical, and cross-sectional imaging features in predicting potentially malignant or malignant cystic lesions of the pancreas? Results from a single institution experience with 220 surgically treated patients

BACKGROUND: This study aims to determine the use of preoperative clinical, biochemical, and cross-sectional imaging features for predicting malignancy in cystic lesions of the pancreas (CLP). STUDY DESIGN: Two hundred twenty patients who underwent operations for CLP or suspected CLP were reviewed. Patients were divided into two groups, patients undergoing operations for pseudocysts and patients undergoing operations for suspected cystic neoplasms. The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated. RESULTS: Forty-four patients with a preoperative diagnosis of pseudocysts underwent operations for complications of pseudocyst. Forty-two were confirmed pathologically to have pseudocysts, but two were found, unexpectedly, to harbor malignant lesions. One hundred seventy-six patients underwent operations for suspected pancreatic cystic neoplasms. There were 70 benign, 51 potentially malignant, and 55 malignant CLP. On multivariate analysis, three factors, ie, elevated serum carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9; cyst size > 3 cm; and presence of one or more of three morphologic features, such as solid component; peripheral calcification; and main duct dilation on cross-sectional imaging were independent predictors of malignancy. Presence of two or three of these factors had a positive predictive value of 88% in predicting a premalignant or malignant CLP. CONCLUSIONS: Most pancreatic pseudocysts can be accurately diagnosed preoperatively. In patients with suspected pancreatic cystic neoplasms, elevated serum CEA or carbohydrate antigen 19-9, cyst size > 3 cm, and presence of suspicious morphologic features on imaging are predictors of potentially malignant or malignant CLP. Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.     

Are the Sendai and Fukuoka Consensus Guidelines for Cystic Mucinous Neoplasms of the Pancreas Useful in the Initial Triage of all Suspected Pancreatic Cystic Neoplasms? A Single-Institution Experience with 317 Surgically-Treated Patients

Background

The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms.

Study Design

Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR^SCG) and low risk (LR^SCG), and according to the FCG as high risk (HR^FCG), worrisome (W^FCG), and low risk (LR^FCG). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology.

Results

The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR^SCG and HR^ICG2012 for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR.

Conclusion

The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR^FCG group can be safely managed conservatively, and those in the HR^FCG group should undergo resection.     

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??Diagnosis and treatment of pancreatic cystic neoplasms??clinical analysis of 132 cases ZHANG Tai-ping*, XIAO Jian-chun, CAO Zhe, et al. *Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, zhao8028@263.net
Abstract Objective To summarize the experience in diagnosis and treatment of pancreatic cystic neoplasms. Methods The clinical data of 132 patients diagnosed with pancreatic cystic neoplasms treated in Peking Union Medical College Hospital from Jan 2009 to Feb 2013 were retrospectively analysis. Results Spleen-preserving distal pancreatectomy, distal pancreatectomy, Beger procedure, Whipple procedure, tumor enucleation, segment resection, total pancreatectomy and biopsy were performed in 79, 10, 3, 15, 12, 7, 1, 5 Patients, respectively. No patient died within the perioperative period. Pancreatic fistula (B and C) occurred in 4 patients (3%), postoperative hemorrhage(B and C) occurred in 7patients (5.3%).All 22 patients in malignant group were followed up from 9 to 45 months. 2 patients died and the others survived without relapse and metastasis .The following factors including old age??P=0.029??, with clinical symptoms??P=0.024??, weight loss??P=0.019??, jaundice??P=0.021??, having solid component or nodule??P=0.015??, big size??P=0.043??, elevated serum CA19-9 and CEA??P=0.006??P=0.009??were significantly correlated with malignant cystic neoplasms of pancreas in univariate analysis. old age??P=0.043??and elevated serum CA19-9??P=0.048??were identified as independent predictive factors for malignancy by multivariate analysis. Conclusion There is no specific symptom of pancreatic cystic neoplasms. Morphological study plays an important role in the diagnosis. Patients with clinical symptoms or highly suspected malignant lesion should be operated in accordance with tumor location, size, and relationship between pancreatic duct, as well as pathological features. The function of the pancreas should be preserved.     

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??Analysis of clinical and pathological features of asymptomatic cystic neoplasms of pancreas DAI Meng-hua*, XU Tao, ZHANG Tai-ping et al. *Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263.net
Abstract Objective To analyze and study clinical and pathological features of incidental cystic neoplasms of pancreas. Methods The clinical data of 126 cases of pancreatic resection performed for cystic neoplasms between January 1984 and June 2008 at Peking Union Medical College Hospital were evaluated retrospectively. Results Among 126 cases of cystic neoplasms of pancreas, 60 cases were asymptomatic including 56 cases of benign and 4 cases of malignant. The benign cases included 28 cases of serous cystic neoplasms, 25 cases of mucinous cystic neoplasms and 3 cases of intraductal papillary mucinous neoplasms. The malignant cases inclued 3 cases of mucinous cystic adenocarcinoma and 1 case of invasive intraductal papillary mucinous neoplasm. Univariate and multivariate analysis showed that gender, tumor size and radiological features(solid component and main duct dilation) were significant different between benign and malignant cystic neoplasm of pancreas. Gender was a predictor of malignant pathology, with male cases having a higher incidence of malignancy (3/11, 27.3%) compared with female cases (1/44, 2.27%; P=0.001). The presence of radiographic features (solid component and main pancreatic duct dilation) was associated with malignancy of cystic neoplasms. Tumor size less than 3cm in diameter was more common in benign, asymptomatic cystic neoplasms of pancreas. Conclusion Among asymptomatic cystic neoplasms of pancreas, the incidence of malignant cases is lower. The study suggests that if tumor size in asymptomatic cases is less than 3cm in diameter without malignant radiographic features (solid component and main pancreatic duct dilation) observation and regular folllow-up can be selected.     

Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size in asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data to support this recommendation. The purpose of this study was to determine the prevalence of malignancy in this group of patients using pancreatic resection databases from five high-volume pancreatic centers to assess the appropriateness of these guidelines. All pancreatic resections performed for cystic neoplasms ≤3 cm in size were evaluated over the time period of 1998–2006. One hundred sixty-six cases were identified, and the clinical, radiographic, and pathological data were reviewed. The correlation with age, gender, and symptoms (abdominal pain, nausea and vomiting, jaundice, presence of pancreatitis, unexplained weight loss, and anorexia), radiographic features suggestive of malignancy by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence of solid component, lymphadenopathy, or dilated main pancreatic duct or common bile duct), and the presence of malignancy was assessed using univariate and multivariate analysis. Among the 166 pancreatic resections for cystic pancreatic tumors ≤3 cm, 135 cases were benign [38 serous cystadenomas, 35 mucinous cystic neoplasms, 60 intraductal papillary mucinous neoplasms (IPMN), 1 cystic papillary tumor, and 1 cystic islet cell tumor], whereas 31 cases were malignant (14 mucinous cystic adenocarcinomas and 13 invasive carcinomas and 4 in situ carcinomas arising in the setting of IPMN). A greater incidence of cystic neoplasms was seen in female patients (99/166, 60%). Gender was a predictor of malignant pathology, with male patients having a higher incidence of malignancy (19/67, 28%) compared to female patients (12/99, 12%; p < 0.02). Older age was associated with malignancy (mean age 67 years in patients with malignant disease vs 62 years in patients with benign lesions (p < 0.05). A majority of the patients with malignancy were symptomatic (28/31, 90%). Symptoms that correlated with malignancy included jaundice (p < 0.001), weight loss (p < 0.003), and anorexia (p < 0.05). Radiographic features that correlated with malignancy were presence of a solid component (p < 0.0001), main pancreatic duct dilation (p = 0.002), common bile duct dilation (p < 0.001), and lymphadenopathy (p < 0.002). Twenty-seven of 31(87%) patients with malignant lesions had at least one radiographic feature concerning for malignancy. Forty-five patients (27%) were identified as having asymptomatic cystic neoplasms. All but three (6.6%) of the patients in this group had benign disease. Of the patients that had no symptoms and no radiographic features, 1 out of 30 (3.3%) had malignancy (carcinoma in situ arising in a side branch IPMN). Malignancy in cystic neoplasms ≤3 cm in size was associated with older age, male gender, presence of symptoms (jaundice, weight loss, and anorexia), and presence of concerning radiographic features (solid component, main pancreatic duct dilation, common bile duct dilation, and lymphadenopathy). Among asymptomatic patients that displayed no discernable radiographic features suggestive of malignancy who underwent resection, the incidence of occult malignancy was 3.3%. This study suggests that a group of patients with small cystic pancreatic neoplasms who have low risk of malignancy can be identified, and selective resection of these lesions may be appropriate.     

Rare tumors of the pancreas

From 1984 to 2001, 486 operations were carried out at the surgical clinic in Gera for pancreatic neoplasms, including 49 patients with rare neoplasms of the pancreas. In 23 patients malignant pancreatic tumors were present (9 solitary metastases, 9 endocrine carcinomas, 2 cystadenocarcinomas, 2 schwannomas and one non-Hodgkin's lymphoma). In 28 benign lesions a resection of the tumor was performed, concerning 8 insulinomas, 8 serous cystadenomas, 3 mucinous cystadenomas and 4 rare cystic tumors. A sarcoidosis, an autoimmune pancreatitis and a radiation fibrosis were diagnosed in 3 patients operated under the suspicion of a malignant pancreatic tumor. By means of own case examples and data from the literature these rare entities are described with their diagnostic and therapeutic special features.     

Lymphoepithelial Cyst of the Pancreas: Report of a Case

An extremely rare case of a lymphoepithelial cyst (LEC) of the pancreas is described herein. A pancreatic cystic tumor was initially detected in a 50-year-old man at a medical checkup. On admission, his serum carbohydrate antigen (CA) 19-9 level was 8 100 U/ml and a computed tomography scan revealed a well-circumscribed multilocular cystic tumor in the pancreatic head and body. Magnetic resonance cholangiopancreatography showed no communication between the pancreatic ducts and the tumor. A distal pancreatectomy with lymph node dissection was performed because the lesion was suspected to be a mucinous cystadenoma or cystadenocarcinoma of the pancreas. However, histological examination revealed that the cyst was lined by stratified squamous epithelium and surrounded by lymphoid tissue, thereby confirming the diagnosis of LEC of the pancreas. The superficial layer of squamous epithelium and the cystic contents were found to be immunohistologically positive for CA19-9. Establishing a preoperative diagnosis of LEC is quite difficult because it resembles other cystic neoplasms of the pancreas in radiographic features and is frequently associated with an elevation of serum tumor markers such as CA19-9. Received: June 21, 1999 / Accepted: March 24, 2000     

Value of 18-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients With Cystic Tumors of the Pancreas

OBJECTIVE: To assess the reliability of 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) in distinguishing benign from malignant cystic lesions of the pancreas. SUMMARY BACKGROUND DATA: The preoperative differential diagnosis of cystic lesions of the pancreas remains difficult: the most important point is to identify malignant or premalignant cysts that require resection. 18-FDG PET is a new imaging procedure based on the increased glucose metabolism by tumor cells and has been proposed for the diagnosis and staging of pancreatic cancer. METHODS: During a 4-year period, 56 patients with a suspected cystic tumor of the pancreas underwent 18-FDG PET in addition to computed tomography scanning, serum CA 19-9 assay, and in some instances magnetic resonance imaging or endoscopic retrograde cholangiopancreatography. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value. The accuracy of 18-FDG PET and computed tomography was determined for preoperative diagnosis of a malignant cyst. RESULTS: Seventeen patients had malignant tumors. Sixteen patients (94%) showed 18-FDG uptake with a standard uptake value of 2.6 to 12.0. Twelve patients (70%) were correctly identified as having malignancy by computed tomography, CA 19-9 assay, or both. Thirty-nine patients had benign tumors: only one mucinous cystadenoma showed increased 18-FDG uptake (standard uptake value 2.6). Five patients with benign cysts showed computed tomography findings of malignancy. Sensitivity, specificity, and positive and negative predictive values for 18-FDG PET and computed tomography scanning in detecting malignant tumors were 94%, 97%, 94%, and 97% and 65%, 87%, 69%, and 85%, respectively. CONCLUSIONS: 18-FDG PET is more accurate than computed tomography in identifying malignant pancreatic cystic lesions and should be used, in combination with computed tomography and tumor markers assay, in the preoperative evaluation of patients with pancreatic cystic lesions. A positive result on 18-FDG PET strongly suggests malignancy and, therefore, a need for resection; a negative result shows a benign tumor that may be treated with limited resection or, in selected high-risk patients, with biopsy, follow-up, or both.     

Outcome of Invasive and Noninvasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas (IPMN): A 10-year Experience

BACKGROUND: Intraductal papillary-mucinous neoplasms (IPMN) were officially introduced into the TNM classification in 1996. Based on a two-center database, we reevaluated histopathological findings, clinicopathological pattern, predictive markers for malignancy, and outcome. METHODS: Between 1996 and 2006, a total of 1424 pancreatic resections were performed in the University Hospitals Dresden and Mannheim. Pathologists of both institutions reviewed the IPMN diagnoses and other with cystic or solid tumor diagnoses. All possible markers, such as diabetes, jaundice, etc., were analyzed for prediction of malignancy. We performed a survival analysis based on the morphologic classification to determine the prognosis of IPMN. RESULTS: There were 43 patients of primarily diagnosed IPMN along with 1174 patients with diagnoses, such as ductal adenocarcinoma. In 207 patients, the diagnoses revealed other cystic or small solid tumors. A histopathological review of the latter patients revealed 54 IPMNs, resulting in a total of 97 IPMN patients (29 noninvasive, 68 invasive). All IPMN patients had a median survival of 36 months. Recurrence occurred more frequently in invasive IPMN. Predictive markers of malignancy were pain, preoperative weight loss, jaundice, and elevated CA 19.9. The strongest independent prognostic factor was invasive growth. The survival analysis revealed excellent prognosis for noninvasive IPMN. CONCLUSIONS: Since the introduction of IPMN in 1996, even specialized centers have had to deal with a learning curve. By reevaluating all cystic or small solid tumors, centers can improve and their patients' treatment can be optimized. Because the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions, surgery is advocated for all main duct IPMN, because they have a high malignant potential. For branch duct IPMN, surgery is advocated if the lesion is symptomatic, >3 cm, or has enlarged nodules.