'Peripheric' pancreatic cysts: performance of CT scan, MRI and endoscopy according to final pathological examination.

OBJECTIVE To assess the accuracy of pre-operative staging in patients with peripheral pancreatic cystic neoplasms (pPCNs). METHODS From 2005 to 2011, 148 patients underwent a pancreatectomy for pPCNs. The pre-operative examination methods of computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) were compared for their ability to predict the suggested diagnosis accurately, and the definitive diagnosis was affirmed by pathological examination. RESULTS A mural nodule was detected in 34 patients (23%): only 1 patient (3%) had an invasive pPCN at the final histological examination. A biopsy was performed in 79 patients (53%) during EUS: in 55 patients (70%), the biopsy could not conclude a diagnosis; the biopsy provided the correct and wrong diagnosis in 19 patients (24%) and 5 patients (6%), respectively. A correct diagnosis was affirmed by CT, EUS and pancreatic MRI in 60 (41%), 103 (74%) and 80 (86%) patients (when comparing EUS and MRI; P = 0.03), respectively. The positive predictive values (PPVs) of CT, EUS and MRI were 70%, 75% and 87%, respectively. CONCLUSIONS Pancreatic MRI appears to be the most appropriate examination to diagnose pPCNs accurately. EUS alone had a poor PPV. Mural nodules in a PCN should not be considered an indisputable sign of pPCN invasiveness.

[1]  T. Banday,et al.  Mucinous Cystic Neoplasms of Pancreas , 2014, Gastroenterology research.

[2]  H. Friess,et al.  European experts consensus statement on cystic tumours of the pancreas. , 2013, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[3]  D. Gouma,et al.  Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions , 2012, Scandinavian journal of gastroenterology.

[4]  H. Yamaue,et al.  The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas , 2012, Annals of surgery.

[5]  K. Lillemoe,et al.  Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? , 2011, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[6]  J. Fleming,et al.  Role of EUS-FNA-Based Cytology in the Diagnosis of Mucinous Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis , 2010, Digestive Diseases and Sciences.

[7]  M. Wallace,et al.  The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study , 2007, Endoscopy.

[8]  Elizabeth Lee-Lewandrowski,et al.  Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. , 2004, Gastroenterology.

[9]  T. Takada,et al.  An introduction to mucin-producing tumors of the pancreas: why they deserve more attention. , 1998, Hepato-gastroenterology.

[10]  R. Walsh,et al.  Presentation and management of cystic neoplasms of the pancreas , 1998, Journal of Gastrointestinal Surgery.

[11]  T. Mattfeldt,et al.  Cystic tumours of the pancreas: diagnostic accuracy, pathologic observations and surgical consequences. , 1998, Langenbeck's archives of surgery.