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Hurtado-Pardo L, Cienfuegos JA, Antoñanzas J, Benito A, Panadero P, Salguero J, Martí-Cruchaga P, Zozaya G, Valentí V, Pardo F, Rotellar F, Hernández Lizoáin JL. Cystic tumors of the pancreas. An update of the surgical experience in a single institution. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:87-93. [PMID: 30404529 DOI: 10.17235/reed.2018.5798/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the aim of the present study was to analyze the clinicopathological features of patients undergoing pancreatic surgical resections due to cystic neoplasms of the pancreas. MATERIAL AND METHODS demographic data, form of presentation, radiologic images and location of the tumors within the pancreas were analyzed. Data was also collected on the type of surgery (open/laparoscopic), postoperative complications and their severity and oncologic outcomes. RESULTS eighty-two pancreatic resections were performed. The mean age of patients was 57 years and 49 (59%) were female. Forty-one tumors (50%) were incidental and the most frequent symptoms in the group of symptomatic patients were abdominal pain (63.4%) and weight loss (36.5%). Thirty-two tumors (39%) were located in the tail of the pancreas, 25 (30.5%) in the head and 20 (24.4%) in the body. Thirty-nine (47.5%) distal pancreatectomies, 16 central, ten duodenal pancreatectomies and one enucleation were performed; 40 (48.5%) were carried out laparoscopically. Mean hospital stay was ten days and eight patients (7%) experienced severe complications, one was a pancreatic fistula. Sixty-six tumors (80.5%) were recorded as non-invasive and 16 (19.5%) as invasive: seven intraductal mucinous papillary tumors, one cystic mucinous tumor, four solid pseudopapillary tumors and four cystic neuroendocrine tumors. There was a median follow-up of 64 months; disease-free survival at five and ten years was 97.4% in the patients with non-invasive tumors and 84.6% and 70.5% in the invasive tumors group (p < 0.01). CONCLUSIONS fifty percent of cystic neoplasms of the pancreas are incidental. Two phenotypes exist, invasive and non-invasive.
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Affiliation(s)
| | | | | | | | - Pablo Panadero
- Anatomía Patológica, Clínica Universidad de Navarra, España
| | - Joseba Salguero
- Cirugía General y Digestiva, Clinica Universidad de Navarra, España
| | | | - Gabriel Zozaya
- Cirugía General y del Aparato Digestivo, Clínica Universidad de Navarra, España
| | - Víctor Valentí
- Cirugía General y Aparato Digestivo, Clínica Universidad de Navarra, España
| | - Fernando Pardo
- Cirugía General y del Aparato Digestivo, Clínica Universidad de Navarra, España
| | - Fernando Rotellar
- Cirugía General y del Aparato Digestivo, Clínica Universidad de Navarra, España
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System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings. J Am Coll Radiol 2018; 15:639-647. [DOI: 10.1016/j.jacr.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 12/21/2022]
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3
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You L, Xiao J, Cao Z, Zhang W, Liao Q, Dai M, Zhang T, Zhao Y. Analysis of clinical characteristics and treatment of pancreatic cystic tumors. Chin J Cancer Res 2016; 28:519-527. [PMID: 27877011 PMCID: PMC5101226 DOI: 10.21147/j.issn.1000-9604.2016.05.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To summarize experience in the diagnosis and treatment of pancreatic cystic neoplasms. Methods This is a retrospective study of 207 patients who were diagnosed with pancreatic cystic tumors at Peking Union Medical College Hospital between Jan 2009 and Mar 2014. Clinical data, such as clinical manifestations, radiological and pathological images and surgical recordings, were collected. Results Of the 207 included patients, females accounted for 76.81%, and the mean patient age was 52.04 years. Malignancy was more common in older patients who presented with marasmus and jaundice. Other risk factors included solid components in the tumor, a large tumor size, and elevated levels of tumor markers. Surgical treatment was required when a malignant tumor was suspected. The operation approach was selected based on the location, size and characteristics of the tumor. The position of the tumor relative to the pancreatic duct also played a significant role. Conclusions No specific symptoms were observed for the patients with pancreatic cystic tumors. Imaging played an important role in making a differential diagnosis. Furthermore, surgical treatment should be proposed for patients with significant symptoms and potentially malignant tumors. The tumor resection rate is high, suggestive of good prognosis.
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Affiliation(s)
- Lei You
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jianchun Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhe Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wanying Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Menghua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Paroder V, Flusberg M, Kobi M, Rozenblit AM, Chernyak V. Pancreatic cysts: What imaging characteristics are associated with development of pancreatic ductal adenocarcinoma? Eur J Radiol 2016; 85:1622-6. [PMID: 27501898 DOI: 10.1016/j.ejrad.2016.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess relationship between pancreatic cysts (PC) and pancreatic ductal adenocarcinoma (PDAC) and to compare imaging features of PC in subjects who develop PDAC and those who do not. MATERIAL AND METHODS This case-control IRB-approved HIPAA-compliant study included patients with PDAC (cases) and lung cancer (controls), diagnosed between 1/1/05-1/1/14. The most recent abdominal CT/MR of each patient done >6months prior to cancer diagnosis date was reviewed by radiologist blinded to case/control status. Presence of PC, number and size of largest PC, presence of main pancreatic duct (MPD) dilatation (MPD >3mm) were recorded. Simple PC was defined as lack of calcifications, septations and enhancement. Logistic regression models with binary outcome of PDAC were constructed. RESULTS There were 88 cases and 273 controls with mean ages of 69.6 years (±10.3) and 69.8 years (±12.0), respectively (p=0.864). PC were present in 21.6% (19/88) cases and in 9.2% (25/273) controls (p=0.002). The OR of PC for development of PDAC was 2.83, adjusting for age, sex and race (p=0.001). Mean PC size was 14.8mm (±8.7) in cases and 7.6mm (±8.0) in controls (p=0.007). PC were solitary in 6 (31.6%) of 19 cases and 21 (84.0%) of 25 controls (p=0.001). There was no significant difference in proportions of simple cysts or MPD dilatation between cases and controls. Multiple PC had 8.2 times increased odds of PDAC compared with solitary PC, adjusting for cyst size (p=0.007). CONCLUSION Multiple PC are associated with 8.2 times higher odds of PDAC compared with solitary PC.
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Affiliation(s)
| | - Milana Flusberg
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Alla M Rozenblit
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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5
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Patients 65 years and older with incidental pancreatic cysts: Is there a relationship between all-cause mortality and imaging follow-up? Eur J Radiol 2016; 85:1115-20. [DOI: 10.1016/j.ejrad.2016.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 02/08/2023]
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Okasha HH, Ashry M, Imam HMK, Ezzat R, Naguib M, Farag AH, Gemeie EH, Khattab HM. Role of endoscopic ultrasound-guided fine needle aspiration and ultrasound-guided fine-needle aspiration in diagnosis of cystic pancreatic lesions. Endosc Ultrasound 2015; 4:132-6. [PMID: 26020048 PMCID: PMC4445171 DOI: 10.4103/2303-9027.156742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 08/13/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. PATIENTS AND METHODS This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. RESULTS Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst amylase could differentiate between neoplastic and nonneoplastic cysts at a level of 1043 with sensitivity of 58%, specificity of 75%, PPV of 73%, NPV of 60%, and accuracy of 66%. CA19-9 could not differentiate between neoplastic and nonneoplastic cysts. Mucin examination showed a sensitivity of 85%, specificity of 95%, PPV of 92%, NPV of 91%, and accuracy of 91% in differentiating mucinous from non-mucinous lesions. Cytopathological examination showed a sensitivity of 81%, specificity of 94%, PPV of 94%, NPV of 83%, and accuracy of 88%. CONCLUSION US or EUS-FNA with analysis of cyst CEA level, CA19-9, amylase, mucin stain, and cytopathological examination increases the diagnostic accuracy of cystic pancreatic lesions.
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Affiliation(s)
| | - Mahmoud Ashry
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Hala M K Imam
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Reem Ezzat
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Naguib
- Department of Internal Medicine, Cairo University, Oula, Giza, Egypt
| | - Ali H Farag
- Department of Internal Medicine, Cairo University, Oula, Giza, Egypt
| | - Emad H Gemeie
- Department of Pathology, National Cancer Institute, Oula, Giza, Egypt
| | - Hani M Khattab
- Department of Pathology, Cairo University, Oula, Giza, Egypt
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Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148:824-48.e22. [PMID: 25805376 DOI: 10.1053/j.gastro.2015.01.014] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- James M Scheiman
- Department of Internal Medicine and Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joo Ha Hwang
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
| | - Paul Moayyedi
- Division of Gastroenterology, Hamilton Health Sciences, Farncombe Family Digestive Health Research Institute, McMaster University Hamilton, Ontario, Canada
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Räty S, Sand J, Laukkarinen J, Vasama K, Bassi C, Salvia R, Nordback I. Cyst fluid SPINK1 may help to differentiate benign and potentially malignant cystic pancreatic lesions. Pancreatology 2013; 13:530-3. [PMID: 24075519 DOI: 10.1016/j.pan.2013.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/04/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Differential diagnosis between benign and potentially malignant cystic pancreatic lesions may be difficult. Previously we have compared cyst fluid serine protease inhibitor Kazal type I (SPINK1) with some traditionally used tumour markers (amylase, CEA, Ca19-9) and found that it may be a new promising maker in the differential diagnosis of cystic pancreatic lesions. In the present study, we focused on cyst fluid SPINK1 levels in benign and potentially malignant cystic pancreatic lesions. DESIGN Sixty-one patients operated on for cystic pancreatic lesion in Tampere University Hospital, Finland and in Verona University Hospital, Italy, were included. Cyst fluid was aspirated during surgery, stored at -70 °C, and analysed with immunofluorometric assay for SPINK1. The final diagnosis was acute pancreatitis with fluid collection (Acute FC) in 4 patients, chronic pseudocyst (PS) in 17 patients, serous cystadenoma (SCA) in 7 patients, mucinous cystadenoma (MCA) in 21 patients and intraductal papillary-mucinous neoplasm (IPMN) in 12 patients (9 main/mixed duct type and 3 branch duct type). RESULTS The acute FC patients had high SPINK1 levels. Among chronic cysts, SPINK1 levels were significantly higher in patients with potentially malignant cysts (main/mixed duct IPMN and MCA) than with benign cysts (side branch IPMN and SCA), (median and range, [480 (13-3602) vs. 18 (0.1-278) μg/L]; p < 0.0001). In the subcohort of 24 patients with <3 cm chronic cyst, cyst fluid SPINK 1 levels were significantly lower in SCA or side branch IPMN (3 [2-116] μg/L) than in main duct IPMN or MCA (638 [66-3602] μg/L; p = 0.018). The best sensitivity and specificity to differentiate any size MCA or main/mixed type IPMN from SCA or side branch IPMN were 85% and 84% (AUC 0.94; cut-off value 118 μg/L). The best sensitivity and specificity to differentiate <3 cm MCA or main duct IPMN from SCA or side branch IPMN were 93% and 89% (AUC 0.98; cut-off value 146 μg/L). CONCLUSIONS Cyst fluid SPINK1 may be a possible marker in the differential diagnosis of benign and potentially malignant cystic pancreatic lesions.
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Affiliation(s)
- Sari Räty
- Department of Gastroenterology and Alimentary Tract Surgery, Finland; ARC-NET Research Center, University and Hospital Trust of Verona, Italy.
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Cho CS, Russ AJ, Loeffler AG, Rettammel RJ, Oudheusden G, Winslow ER, Weber SM. Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol 2013; 20:3112-9. [PMID: 23595223 DOI: 10.1245/s10434-013-2986-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Clifford S Cho
- Section of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, J4/703 Clinical Sciences Center, 600 Highland Avenue, Madison, WI, USA.
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Abstract
BACKGROUND The management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history. OBJECTIVES This study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis. METHODS Asymptomatic cysts were identified from a prospectively maintained database. Sequential cross-sectional imaging studies were assessed, and results of endoscopic ultrasound-guided aspiration were co-analysed. RESULTS A total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow-up was 5.1 years [interquartile range (IQR): 4.1-6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6-1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7-1.6 cm) during follow-up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0-3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0-4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post-presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions. CONCLUSIONS Asymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis.
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Affiliation(s)
- Gareth Morris-Stiff
- Department of General Surgery, Section of Surgical Oncology and Hepatopancreatobiliary Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Sotoudehmanesh R, Arab P, Ali-Asgari A. Incidental Findings on Upper Gastrointestinal Endoscopic Ultrasonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313476918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this prospective study was to assess the frequency and clinical significance of incidental findings on upper gastrointestinal endoscopic ultrasonography (EUS). Methods: Patients referred for upper gastrointestinal EUS were consecutively enrolled into this prospective study. Any coincidental abnormality found during standard EUS was considered an incidental finding. Significant incidental findings were defined as abnormalities that required further medical, surgical, or endoscopic intervention, including surveillance. Results: In 552 patients who underwent EUS, 41 incidental findings were detected in 39 patients (7.1%). Twenty-one abnormalities had clinical significance. The frequency of incidental findings increased significantly with increasing age ( P = .001). The most frequent incidental findings were gallstones, subepithelial lesions, and pancreatic lesions. Conclusions: Incidental findings on EUS are not uncommon in clinical practice and might be a clue to a significant pathology. The appropriate extent of evaluation of incidental findings noted during a standard EUS procedure warrants further research yet to be defined.
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Affiliation(s)
| | - Payman Arab
- Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ali-Asgari
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
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Percutaneous fine needle biopsy in pancreatic tumors: a study of 42 cases. Gastroenterol Res Pract 2012; 2012:908963. [PMID: 23304130 PMCID: PMC3530801 DOI: 10.1155/2012/908963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/19/2012] [Accepted: 11/22/2012] [Indexed: 01/12/2023] Open
Abstract
The technological progress within the range of methods of pancreas imaging and their more common accessibility selects a group of patients requiring a microscopic diagnosis. Percutaneous fine needle aspiration biopsy under the control of ultrasonography (PCFNA/USG) is the method commonly used in determining the character of a focal pancreatic lesion. Aim of the Work. An assessment of the accessibility of PCFNA biopsy in the assessment of solid and cystic changes in a pancreas and the correlation of the results of imaging examination, cytological smear and concentration of a serous marker CA19-9. Material and Methodology. In our material we analysed 43 cases of tumors of the pancreas among the patients who were at the average age of 59 ± 10.4 (14 women, 28 men) diagnosed by PCFNA biopsy. Results. In a group we are 23 cases of cancer, 12 cases of inflammation and 7 cases of cellular atypia for which 2 cases of IPMN were included. The sensitivity of the method was 92.5% but specificity was 68%. In our opinion PCFNA/USG is a method of the comparable sensitivity and specificity with fine needle aspiration biopsy with EUS control and its efficiency depends to a considerable degree on experience and interdisciplinary collaboration.
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Incidentally discovered solid pancreatic masses: imaging and clinical observations. ACTA ACUST UNITED AC 2012; 37:91-7. [PMID: 21394600 DOI: 10.1007/s00261-011-9720-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to review the CT findings and clinical outcome in patients with incidentally discovered solid pancreatic masses. MATERIALS AND METHODS Over an 8-year period, from 2001 to 2009, we identified 24 patients with solid pancreatic masses incidentally detected by CT. There were 13 females and 11 males, with a mean age of 67 years. We determined the indication for initial CT, analyzed the CT features, and ascertained the clinical follow-up in all the patients. RESULTS All of the solid masses were malignant. There were 14 adenocarcinomas and 10 neuroendocrine tumors. The most common indications for the initial CT were surveillance of an extrapancreatic malignancy (n = 10) and evaluation for hematuria (n = 6). On the initial CT, 16 of the patients (67%) had a clearly visible pancreatic mass. In eight patients isoattenuating masses were identified, only recognized by subtle signs including unexplained dilatation of the pancreatic duct (n = 5) or minimal contour deformity or density of the pancreas (n = 3). The mean survival time for the patients with adenocarcinoma was 21.6 months, and 42 months for the patients with neuroendocrine tumors. CONCLUSION Although uncommon, incidentally discovered solid pancreatic masses are malignant neoplasms, either ductal adenocarcinomas or neuroendocrine tumors. Unlike incidentally discovered small cystic lesions, solid pancreatic lesions are often biologically aggressive.
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Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK. Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol 2012; 8:762-7. [PMID: 22051458 DOI: 10.1016/j.jacr.2011.05.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/26/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate for agreement with respect to how radiologists report incidental findings encountered on CT. METHODS A multiple-choice survey was designed to query radiologists about how they handle 12 incidental findings on body CT, assuming the patient is a 45-year-old woman with no history of malignancy. Included were a 1-cm thyroid nodule, a 5-mm noncalcified lung nodule, coronary artery calcification, a 2-cm adrenal nodule, a 2-cm pancreatic cyst, a 1-cm enhancing liver lesion, a 2-cm high-density renal cyst, short-segment small bowel intussusception, a 1-cm splenic cyst, focal gallbladder wall calcification, and a 3-cm ovarian cyst in both a premenopausal woman and a postmenopausal woman. Choices ranged from "do not report" to advising interventional procedures tailored to the organ. Surveys were administered to body CT attending radiologists at 3 academic institutions. RESULTS Twenty-seven radiologists completed the survey. The mean experience level was 15.7 years after training. Seventy percent or greater agreement on interpretation was identified for only 6 findings: recommend ultrasound for a 1-cm thyroid nodule, recommend ultrasound for a 3-cm cyst in postmenopausal woman, follow Fleischner Society recommendations for a 5-mm lung nodule, describe only coronary calcification, and describe as likely benign both short-segment small bowel intussusception and a 1-cm splenic cyst. CONCLUSIONS Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence.
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Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Abstract
PURPOSE OF REVIEW Imaging of the pancreas is critical for diagnostic decision-making. Improvements in imaging have the potential to translate into improved patient outcomes by more accurate and rapid diagnosis. Evolving approaches to imaging for pancreatic diseases in the past year are reviewed. RECENT FINDINGS The approach to patients with cystic lesions continues to focus on careful patient selection for surgery and targeted use of imaging and cyst sampling. Intraductal papillary mucinous neoplasm patients appear to have cancer risk independent of the neoplastic cyst itself. Imaging continues to focus on improved approaches to differentiation of inflammatory from neoplastic pancreatic mass lesions. SUMMARY The approach to patients with suspected pancreatic disease continues to evolve, thanks to improved imaging. Recently developed diagnostic and treatment strategies show promise for improved patient outcomes.
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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; discussion 600-3. [PMID: 21463795 DOI: 10.1016/j.jamcollsurg.2011.01.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years. STUDY DESIGN A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010. RESULTS A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%. CONCLUSION Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection.
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Kongkam P, Rerknimitr R, Ridtitid W, Pausawasdi N, Akaraviputh T, Ratanachu-ek T, Pisespongsa P, Ovartlarnporn B. EUS-FNA for pancreatic cyst lesion, today and tomorrow in the Kingdom of Thailand. Dig Endosc 2011; 23 Suppl 1:54-7. [PMID: 21535203 DOI: 10.1111/j.1443-1661.2011.01140.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unlike endoscopic retrograde cholangiopancreatography (ERCP) service, endoscopic ultrasonography (EUS) service in Thailand is at its elementary state. Currently, there are only 11 hospitals in Thailand carrying out EUS whereas there are more than 50 hospitals carrying out ERCP. This is a multicenter questionnaire survey that obtained information on EUS practice for pancreatic cysts. Of those 11 hospitals, only three hospitals provided enough number of patients with pancreatic cysts undergoing EUS. There were many differences in endosonographers opinions regarding specific information in the pancreatic cyst. In addition, the threshold to carry out and not to carry out fine needle aspiration are varies.
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Affiliation(s)
- Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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