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. 2021 Nov 22:48:e20213009.
doi: 10.1590/0100-6991e-20213009. eCollection 2021.

Non-inflammatory pancreatic cysts: from diagnosis to treatment (97 cases series)

[Article in English, Portuguese]
Enio Campos Amico  1   2 , Caio Trajano Siqueira Salgado  2 , José Roberto Alves  3 , Adriano DE Araújo Lima Liguori  4 , Rogério Lacerda Sousa  4
Affiliations

Non-inflammatory pancreatic cysts: from diagnosis to treatment (97 cases series)

[Article in English, Portuguese]
Enio Campos Amico et al. Rev Col Bras Cir. .

Abstract
in English, Portuguese

Objective: to describe the implications of the diagnosis and treatment of non-inflammatory pancreatic cysts in a series of patients.

Methods: we included patients with pancreatic cysts ≥1.0 cm, excluding those with a presumptive diagnosis of a pseudocyst. Imaging tests, echoendoscopy, and histopathology determined the diagnosis of the type of cyst. We applied the guidelines of the International Association of Pancreatology, with some modifications, in patients with mucinous or indeterminate lesions.

Results: 97 adult patients participated in the study. A cystic neoplasm of the pancreas was diagnosed in 82.5% of cases. Diagnosis was mainly made by magnetic resonance (46% of cases). The two most common diagnoses were intraductal papillary mucinous neoplasm (43.3%) and serous cystadenoma (26%). Twenty-nine patients underwent surgery (33.3%). The most common surgical procedure was distal pancreatectomy associated with splenectomy in 19 cases (65.5%). Among the operated patients, 11 were diagnosed with cancer. None of the followed, non-operated patients had a diagnosis of cancer.

Conclusions: magnetic resonance showed good accuracy, particularly in the diagnosis of intraductal papillary mucinous neoplasm. The guidelines of the International Association of Pancreatology, as applied in this study, showed a negative predictive value for cancer of 100%. A development of better diagnostic tests can reduce the number of unnecessary operations.

Objetivo:: descrever as implicações do diagnóstico e tratamento dos cistos não inflamatórios do pâncreas em série de pacientes.

Metódos:: foram incluídos pacientes com cisto de pâncreas ≥1,0cm excluindo aqueles com diagnóstico presuntivo de pseudocisto. Exames de imagem, ecoendoscopia e anatomia-patológica determinaram o diagnóstico do tipo de cisto. As diretrizes da Associação Internacional de Pancreatologia foram aplicadas, com algumas modificações, nos pacientes com lesões mucinosas ou indeterminadas.

Resultados:: noventa e sete pacientes adultos participaram do estudo. A neoplasia cística de pâncreas foi diagnosticada em 82,5% dos casos. O diagnóstico foi feito principalmente por ressonância magnética (46% dos casos). Os dois diagnósticos mais frequentes foram a neoplasia papilar intraductal mucinosa (43,3%), e o cistoadenoma seroso (26%). Vinte e nove pacientes foram submetidos a operação (33,3%). O procedimento cirúrgico mais comum foi a pancreatectomia corpo-caudal associada à esplenectomia em 19 casos (65,5%). Entre os pacientes operados, 11 tiveram o diagnóstico de câncer. Nenhum dos pacientes seguidos teve o diagnóstico de câncer.

Conclusões:: a ressonância magnética apresentou boa acurácia, particularmente no diagnóstico da neoplasia papilar intraductal mucinosa. As diretrizes da Associação Internacional de Pancreatologia da forma que foram aplicadas no presente estudo, mostraram valor preditivo negativo para o câncer de 100%. O desenvolvimento de estratégias diagnósticas com melhor acurácia podem reduzir o número de cirurgias desnecessárias.

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Conflict of interest statement

Conflict of interest: no.

Figures

Figure 1
Figure 1. Typical PCN cases in imaging exams. A. MRI shows a microcystic lesion typical of SCA; B. MRI showing a pancreatic cyst with incomplete septa, typical of mucinous cystadenoma; C. MRI with multiple BD-IPMN; the MPD with normal diameter is observed throughout its extension. D. CT showing a patient with MD-IPMN; there is dilated MPD (11mm) in the pancreatic body without an identifiable obstructive factor. PCN: pancreatic cystic neoplasm; MRI: magnetic resonance imaging; BD-IPMN: branch duct intraductal papillary mucinous neoplasm; SCA: serous cystadenoma; MPD: main pancreatic duct; CT: computerized tomography; MD-IPMN: main duct intraductal papillary mucinous neoplasm.
Figure 2
Figure 2. IPMN cases in endoscopic and imaging exams. A. EE in a patient with BD-IPMN, in which a nodule is found on the cyst wall; B. MRI showing M-IPMN (7mm MPD); C. MRI showing MD-IPMN (20mm MPD); D. MD-IPMN surgical specimen showing a solid component (invasive adenocarcinoma). IPMN: intraductal papillary mucinous neoplasm; EE: echoendoscopy; BD-IPMN: branch duct intraductal papillary mucinous neoplasm; MRI: magnetic resonance imaging; M-IPMN: mixed intraductal papillary mucinous neoplasm; MD-IPMN: main duct intraductal papillary mucinous neoplasm; MPD: main pancreatic duct.
Figure 3
Figure 3. Flowchart of patients with IPMN with types of exams carried out, moment of surgical indication, and follow-up approach. In red, we highlight the cases of surgical indication outside the Fukuoka guideline. Reasons for surgical indication: (*1) five patients for suspected solid component and two for MPD >10mm; (*2) for >2 worrisome factors; (*3) two patients for suspected MPD involvement and one for solid component; (*4) for >2 worrisome factors; (*5) for suspected MPD involvement. IPMN: intraductal papillary mucinous neoplasm; MPD: main pancreatic duct.
See this image and copyright information in PMC

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