BACKGROUND: Optimal management of pancreatic cystic neoplasms includes identification and resection of mucinous neoplasms. This study was performed to assess the accuracy of preoperative variables in determining a mucinous lesion. METHODS: Patients referred for a cystic neoplasm were prospectively assessed by presenting symptoms, blinded radiologic review, and endoscopic ultrasound-guided cyst aspirate analysis. Patients who were symptomatic, or had aspirate findings of a mucinous neoplasm were resected. RESULTS: Eighty-seven patients were enrolled over a 22-month period ending in December 2001. There were 56 (64%) women and 31 (36%) men, with a mean age of 63 (27-86) years. Thirty-five (40%) patients were resected including 24 (69%) women and 11 (31%) men with a mean age of 58 years. Twenty-eight (80%) patients who had resection were symptomatic. Specimen histology included 18 (51%) mucinous neoplasms, 8 (23%) serous neoplasms, 4 (11%) ductal or neuroendocrine carcinomas, and 3 (9%) pseudocysts. The positive predictive value (PPV) for cyst-aspirate extracellular mucin (83%) was significant in predicting a mucinous neoplasm (P =.009). No other aspirate variables (amylase, carcinoembryonic antigen, CA15-3, viscosity), or patient characteristics were predictive of final histology. Diagnostic agreement between all 3 radiologists was 8% (P =.98). At a median follow-up of 12 months, no patients who were observed required resection. CONCLUSIONS: Patients with suspected pancreatic cystic neoplasms can be selectively treated on the basis of symptoms and cyst-aspirate mucin analysis. Symptomatic and mucin containing lesions should be resected.
BACKGROUND: Optimal management of pancreatic cystic neoplasms includes identification and resection of mucinous neoplasms. This study was performed to assess the accuracy of preoperative variables in determining a mucinous lesion. METHODS:Patients referred for a cystic neoplasm were prospectively assessed by presenting symptoms, blinded radiologic review, and endoscopic ultrasound-guided cyst aspirate analysis. Patients who were symptomatic, or had aspirate findings of a mucinous neoplasm were resected. RESULTS: Eighty-seven patients were enrolled over a 22-month period ending in December 2001. There were 56 (64%) women and 31 (36%) men, with a mean age of 63 (27-86) years. Thirty-five (40%) patients were resected including 24 (69%) women and 11 (31%) men with a mean age of 58 years. Twenty-eight (80%) patients who had resection were symptomatic. Specimen histology included 18 (51%) mucinous neoplasms, 8 (23%) serous neoplasms, 4 (11%) ductal or neuroendocrine carcinomas, and 3 (9%) pseudocysts. The positive predictive value (PPV) for cyst-aspirate extracellular mucin (83%) was significant in predicting a mucinous neoplasm (P =.009). No other aspirate variables (amylase, carcinoembryonic antigen, CA15-3, viscosity), or patient characteristics were predictive of final histology. Diagnostic agreement between all 3 radiologists was 8% (P =.98). At a median follow-up of 12 months, no patients who were observed required resection. CONCLUSIONS:Patients with suspected pancreatic cystic neoplasms can be selectively treated on the basis of symptoms and cyst-aspirate mucin analysis. Symptomatic and mucin containing lesions should be resected.
Authors: John C Mansour; Lawrence Schwartz; Neeta Pandit-Taskar; Michael D'Angelica; Yuman Fong; Steven M Larson; Murray F Brennan; Peter J Allen Journal: J Gastrointest Surg Date: 2006-12 Impact factor: 3.452
Authors: Abdullah Al-Rashdan; C Max Schmidt; Mohammad Al-Haddad; Lee McHenry; Julia Kim Leblanc; Stuart Sherman; John Dewitt Journal: J Gastrointest Oncol Date: 2011-12
Authors: Peter J Allen; Michael D'Angelica; Mithat Gonen; David P Jaques; Daniel G Coit; William R Jarnagin; Ronald DeMatteo; Yuman Fong; Leslie H Blumgart; Murray F Brennan Journal: Ann Surg Date: 2006-10 Impact factor: 12.969
Authors: James M Kiely; Attila Nakeeb; Richard A Komorowski; Stuart D Wilson; Henry A Pitt Journal: J Gastrointest Surg Date: 2003-11 Impact factor: 3.452
Authors: Kristine S Spinelli; Travis E Fromwiller; Roger A Daniel; James M Kiely; Attila Nakeeb; Richard A Komorowski; Stuart D Wilson; Henry A Pitt Journal: Ann Surg Date: 2004-05 Impact factor: 12.969
Authors: Peter J Allen; David P Jaques; Michael D'Angelica; Wilbur B Bowne; Kevin C Conlon; Murray F Brennan Journal: J Gastrointest Surg Date: 2003-12 Impact factor: 3.452
Authors: William E Fisher; Sally E Hodges; Vivek Yagnik; Fannie E Morón; Meng-Fen Wu; Susan G Hilsenbeck; Isaac L Raijman; F Charles Brunicardi Journal: HPB (Oxford) Date: 2008 Impact factor: 3.647
Authors: Abdulrahman M Aljebreen; Joseph Romagnuolo; Rafael Perini; Francis Sutherland Journal: World J Gastroenterol Date: 2007-08-07 Impact factor: 5.742