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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2013

01-09-2013 | Pancreatic Tumors

Preoperative Classification of Pancreatic Cystic Neoplasms: The Clinical Significance of Diagnostic Inaccuracy

Authors: Clifford S. Cho, MD, Andrew J. Russ, MD, Agnes G. Loeffler, MD, PhD, Robert J. Rettammel, MA, Gregory Oudheusden, Emily R. Winslow, MD, Sharon M. Weber, MD

Published in: Annals of Surgical Oncology | Issue 9/2013

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Abstract

Background

The potential for malignant transformation varies among pancreatic cystic neoplasms (PCN) subtypes. Imaging and cyst fluid analysis are used to identify premalignant or malignant cases that should undergo operative resection, but the accuracy of operative decision-making process is unclear. The objective of this study was to characterize misdiagnoses of PCN and determine how often operations are undertaken for benign, non-premalignant disease.

Methods

A retrospective analysis of patients undergoing pancreatic resection for the preoperative diagnosis of PCN was undertaken. Preoperative and pathological diagnoses were compared to measure diagnostic accuracy.

Results

Between 1999 and 2011, 74 patients underwent pancreatic resection for the preoperative diagnosis of PCN. Preoperative classification of mucinous vs. non-mucinous PCN was correct in 74 %. The specific preoperative PCN diagnosis was correct in 47 %, but half of incorrect preoperative diagnoses were clinically equivalent to the pathological diagnoses. The likelihood that the pathological diagnosis was of higher malignant potential than the preoperative diagnosis was 7 %. In 20 % of cases, the preoperative diagnosis was premalignant or malignant, but the pathological diagnosis was benign. Diagnostic accuracy and the rate of undercall diagnoses and overcall operations did not change with the use of EUS or during the time period of this analysis.

Conclusions

Precise, preoperative classification of PCN is frequently incorrect but results in appropriate clinical decision-making in three-quarters of cases. However, one in five pancreatic resections performed for PCN was for benign disease with no malignant potential. An appreciation for the rate of diagnostic inaccuracies should inform our operative management of PCN.
Literature
1.
Gajoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212:590–600.CrossRef
2.
Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.PubMedCrossRef
3.
Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol. 2007;102:2339–49.PubMedCrossRef
4.
Bose D, Tamm E, Liu J, et al. Multidisciplinary management strategy for incidental cystic lesions of the pancreas. J Am Coll Surg. 2010;211:205–15.PubMedCrossRef
5.
Leung KK, Ross WA, Evans D, et al. Pancreatic cystic neoplasm: the role of cyst morphology, cyst fluid analysis, and expectant management. Ann Surg Oncol. 2009;16:2818–24.PubMedCrossRef
6.
Donahue TR, Hines OJ, Farrell JJ, et al. Cystic neoplasms of the pancreas: results of 114 cases. Pancreas. 2010;39:1271–6.PubMedCrossRef
7.
Correa-Gallego C, Ferrone CR, Thayer SP, et al. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology. 2010;10:144–50.PubMedCrossRef
8.
Lewandrowski KB, Southern JF, Pins MR, et al. Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Ann Surg. 1993;217:41–7.PubMedCrossRef
9.
Allen PJ, Jaques DP, D’Angelica M, et al. Cystic lesions of the pancreas: selection criteria for operative and nonoperative management in 209 patients. J Gastrointest Surg. 2003;7:970–7.PubMedCrossRef
10.
Ryu JK, Woo SM, Hwang JH, et al. Cyst fluid analysis for the differential diagnosis of pancreatic cysts. Diagn Cytopathol. 2004;31:100–5.PubMedCrossRef
11.
Brugge WR, Lweandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–6.PubMedCrossRef
12.
Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasm of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–85.PubMedCrossRef
13.
Sahani DV, Kadavigere R, Saokar A, et al. Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics. 2005;25:1471–84.PubMedCrossRef
14.
van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005;62:383–9.PubMedCrossRef
15.
Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;246:571–9.CrossRef
16.
Jang JY, Kim SW, Lee SE, et al. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg. Oncol. 2008;15:199–205.PubMedCrossRef
17.
Ceppa EP, De la Fuente SG, Reddy SK, et al. Defining criteria for selective operative management of pancreatic cystic lesions: does size really matter? J Gastrointest Surg. 2010;14:236–44.PubMedCrossRef
18.
Cizniger S, Turner B, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas. 2011;40:1024–8.CrossRef
19.
Procacci C, Biasiutti C, Carbognin G, et al. Characterization of cystic tumors of the pancreas: CT accuracy. J Comput Assist Tomogr. 1999;23:906–12.PubMedCrossRef
20.
Curry CA, Eng J, Horton K, et al. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol. 2000;175:99–103.PubMedCrossRef
21.
Ahmad NA, Kochman ML, Bernsinger C, et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc. 2003;58:59–64.PubMedCrossRef
22.
Allen PJ, D’Angelica M, Gonen M, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572–82.PubMed
Metadata
Title
Preoperative Classification of Pancreatic Cystic Neoplasms: The Clinical Significance of Diagnostic Inaccuracy
Authors
Clifford S. Cho, MD
Andrew J. Russ, MD
Agnes G. Loeffler, MD, PhD
Robert J. Rettammel, MA
Gregory Oudheusden
Emily R. Winslow, MD
Sharon M. Weber, MD
Publication date
01-09-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2986-6

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