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Comparative Study
. 2010 Aug;211(2):205-15.
doi: 10.1016/j.jamcollsurg.2010.03.034. Epub 2010 Jun 8.

Multidisciplinary management strategy for incidental cystic lesions of the pancreas

Debashish Bose  1 , Eric Tamm, Jun Liu, Leonardo Marcal, Aparna Balachandran, Priya Bhosale, Jason B Fleming, Jeffrey E Lee, Douglas B Evans, Rosa F Hwang
Affiliations
Comparative Study

Multidisciplinary management strategy for incidental cystic lesions of the pancreas

Debashish Bose et al. J Am Coll Surg. 2010 Aug.

Abstract

Background: At our institution, incidental pancreatic cysts are frequently identified in asymptomatic patients undergoing routine imaging for staging of nonpancreatic malignancies. Management of these patients is unclear because a small but significant number of incidental pancreatic cysts are malignant.

Study design: Our institutional database was reviewed for patients with ICD-9 codes for pancreatic cysts from 1980 to 2005. Clinicopathologic factors, including CT and endoscopic ultrasound (EUS) characteristics and management strategies, were analyzed.

Results: Over 25 years, 942 patients were identified with pancreatic cysts. Excluding those with symptoms or pseudocysts, 350 patients remained with incidental pancreatic cysts. Mean overall survival was 41.4 months (mean follow-up 32.7 months). Forty-one patients underwent resection, of whom 38 (92.7%) had premalignant or malignant pathology. Univariate analysis of variables predicting pathologic premalignant or malignant diagnosis identified pancreatic neck or body location as significant factors.

Conclusions: These data suggest that most incidental pancreatic cysts can be managed nonoperatively using a selective strategy based on detailed review of CT imaging and EUS findings.

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Figures

Figure 1
Figure 1
Flow diagram of diagnosis and management of 350 incidental cystic lesions. Based on initial radiologic diagnosis (by re-evaluation of imaging, if available, or radiologic diagnosis at the time of initial study), an initial diagnosis was assigned to each patient in terms of 3 diagnostic categories: benign, malignant, and mucinous. Ninety-nine of these patients underwent endoscopic evaluation (“EUS/FNA” column). EUS/FNA changed the working diagnosis in 25 patients (“Δ Dx” column), with the resulting changes in the number of patients in each category indicated. Forty-one patients underwent resection (“Resected” column), with the pathologic results shown (“Path Dx” column). Finally, a final diagnosis was assigned to each patient based on the pathology results, when available, or the clinical impression based on radiologic, EUS, and clinical factors.
Figure 2
Figure 2
Patients with a final diagnosis of malignant cystic lesions. Patients are presented in terms of their initial diagnosis and the specific clinical entities with which they were diagnosed.
See this image and copyright information in PMC

References

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