Diagnostic evaluation of cystic pancreatic lesions

Visser, Brendan C.; Muthusamy, V. Raman; Yeh, Benjamin M.; Coakley, Fergus V.; Way, Lawrence W.

doi:10.1080/13651820701883155

Cited by 55 publications

(37 citation statements)

References 47 publications

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“…The other question is the nature of the lesion and whether it is benign or malignant. Taking careful clinical history and using the imaging modalities and biochemical markers described below could be helpful to establish a preoperative diagnosis although making a definitive preoperative diagnosis may still not be possible [22]. Caution should be exercised when interpreting the clinical and radiological findings.…”

Section: Diagnosismentioning

confidence: 99%

“…Caution should be exercised when interpreting the clinical and radiological findings. In particular, clinical history of pancreatitis and hyperamylasaemia should be interpreted with caution as IPMN can present with acute pancreatitis by compression of the pancreatic duct or occlusion of the pancreatic secretion [22] [23]. Indeed, mucinous cystadenoma with histologically proved ovarian like stroma has been reported to present with acute pancreatitis [24].…”

Section: Diagnosismentioning

confidence: 99%

“…Differentiating benign from malignant lesions may still be difficult on CT [22]. The diagnostic accuracy of CT has been reported to range between 20% and 90%.…”

Section: Imagingmentioning

confidence: 99%

“…For all tumours, if it remains impossible to make a definitive diagnosis after all the above described investigations, resection should be considered [22].…”

Section: Managementmentioning

confidence: 99%

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Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Elkak¹

2016

JCT

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Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours. The understanding of the pathology, clinical features, diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed database research was performed. Relevant articles published in English were identified and scrutinized. Duplications of information and persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be differentiated from pancreatic pseudocysts. Cystic tumours could be classified into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these tumours should be regarded, at least, as potentially malignant but they may be frankly malignant. The age of the patient and site of the lesion may be helpful in the diagnosis. In particular, MCN is always encountered in females in their middle age and often in the body and tail of the pancreas. Many of these tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be interpretted with caution as IPMN may present as pancreatitis. CT is the primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP have all been utilised. Biochemical markers are of limited value in the diagnosis. Conclusions: Management decision depends primarily on the understanding of pathology and on how confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation performed for most other tumours according to the location of the lesion which means that distal pancreatectomy is usually the operation performed for MCN. Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all been described in the literature. Laparoscopy is more suitable for benign or low grade malignant tumours in the context of distal pancreatectomy. Spleen should be preserved unless splenectomy is

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

“…Differentiating benign from malignant lesions may still be difficult on CT [22]. The diagnostic accuracy of CT has been reported to range between 20% and 90%.…”

Section: Imagingmentioning

confidence: 99%

“…For all tumours, if it remains impossible to make a definitive diagnosis after all the above described investigations, resection should be considered [22].…”

Section: Managementmentioning

confidence: 99%

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Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Elkak¹

2016

JCT

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“…This could be explained by a diagnostic superiority of MRI. However, previous studies showed that CT and MRI have an equal diagnostic accuracy for the characterization of CPTs [22,25]. Other authors rate MRI as more specific than CT due to a better depiction of septae and cyst contents as well as the pancreatic duct, especially with the use of MRCP [4, 26 -30].…”

mentioning

confidence: 99%

Morphological Analysis and Differentiation of Benign Cystic Neoplasms of the Pancreas Using Computed Tomography and Magnetic Resonance Imaging

Grieser

Heine

Stelter

et al. 2012

Fortschr Röntgenstr

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Purpose: To evaluate morphologic characteristics and establish a standardized diagnostic algorithm to differentiate benign cystic pancreatic tumors (CPTs) in non-pancreatitis patients using multidetector computed tomography (CT) and magnetic resonance imaging (MRI). Materials and Methods: Patients with histopathologically proven CPTs who had undergone MRI and/or CT and subsequent tumor resection in our institution were retrospectively identified. Images were analyzed for morphology and enhancement patterns by three independent blinded observers. Preoperative image findings were correlated with histopathological results. Based on the evaluated morphologic parameters, a standardized diagnostic algorithm was designed to help characterize the lesions. Results: A total of 62 consecutive patients with 64 CPTs were identified from the surgical database (21 intraductal papillary mucinous neoplasms; 10 mucinous cystic neoplasms; 12 serous microcystic adenomas; 3 serous oligocystic adenomas; 6 solid pseudopapillary tumors; 12 neuroendocrine neoplasms). The overall averaged accuracy for the 3 observers was 89.9?% for CT and 93.1?% for MRI with increasing overall accuracy in relation to the experience of the observer (88.2?%, 91.5?%, and 93.8?%, respectively). Overall, the generalized kappa value was 0.69 (CT, 0.64; MRI, 0.76); p?

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Imaging modalities for characterising focal pancreatic lesions

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Rawji

Pereira

et al. 2017

Cochrane Database of Systematic Reviews

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Diagnostic evaluation of cystic pancreatic lesions

Abstract: The diagnosis of CPN remains challenging. Cross-sectional imaging methods do not reliably give an accurate preoperative diagnosis. Surgeons should continue to err on the side of resection.

Cited by 55 publications

References 47 publications

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Morphological Analysis and Differentiation of Benign Cystic Neoplasms of the Pancreas Using Computed Tomography and Magnetic Resonance Imaging

Imaging modalities for characterising focal pancreatic lesions

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