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.
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.
Authors: Debashish Bose; Eric Tamm; Jun Liu; Leonardo Marcal; Aparna Balachandran; Priya Bhosale; Jason B Fleming; Jeffrey E Lee; Douglas B Evans; Rosa F Hwang Journal: J Am Coll Surg Date: 2010-06-08 Impact factor: 6.113
Authors: Dushyant V Sahani; Rajgopal Kadavigere; Anuradha Saokar; Carlos Fernandez-del Castillo; William R Brugge; Peter F Hahn Journal: Radiographics Date: 2005 Nov-Dec Impact factor: 5.333
Authors: Sevdenur Cizginer; Brian G Turner; Brian Turner; A Reyyan Bilge; Cetin Karaca; Martha B Pitman; William R Brugge Journal: Pancreas Date: 2011-10 Impact factor: 3.327
Authors: Nuzhat A Ahmad; Michael L Kochman; Colleen Brensinger; William R Brugge; Douglas O Faigel; Frank G Gress; Michael B Kimmey; Nicholas J Nickl; Thomas J Savides; Michael B Wallace; Maurits J Wiersema; Gregory G Ginsberg Journal: Gastrointest Endosc Date: 2003-07 Impact factor: 9.427
Authors: William R Brugge; Kent Lewandrowski; Elizabeth Lee-Lewandrowski; Barbara A Centeno; Tara Szydlo; Susan Regan; Carlos Fernandez del Castillo; Andrew L Warshaw Journal: Gastroenterology Date: 2004-05 Impact factor: 22.682
Authors: Stefano Crippa; Roberto Salvia; Andrew L Warshaw; Ismael Domínguez; Claudio Bassi; Massimo Falconi; Sarah P Thayer; Giuseppe Zamboni; Gregory Y Lauwers; Mari Mino-Kenudson; Paola Capelli; Paolo Pederzoli; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2008-04 Impact factor: 12.969
Authors: Eugene P Ceppa; Sebastian G De la Fuente; Srinevas K Reddy; Sandra S Stinnett; Bryan M Clary; Douglas S Tyler; Theodore N Pappas; Rebekah R White Journal: J Gastrointest Surg Date: 2010-02 Impact factor: 3.452
Authors: Sam L Ivry; Jeremy M Sharib; Dana A Dominguez; Nilotpal Roy; Stacy E Hatcher; Michele T Yip-Schneider; C Max Schmidt; Randall E Brand; Walter G Park; Matthias Hebrok; Grace E Kim; Anthony J O'Donoghue; Kimberly S Kirkwood; Charles S Craik Journal: Clin Cancer Res Date: 2017-04-19 Impact factor: 12.531
Authors: Anne Marie Lennon; Christopher L Wolfgang; Marcia Irene Canto; Alison P Klein; Joseph M Herman; Michael Goggins; Elliot K Fishman; Ihab Kamel; Matthew J Weiss; Luis A Diaz; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Ralph H Hruban Journal: Cancer Res Date: 2014-06-12 Impact factor: 12.701
Authors: Yousuke Nakai; Takuji Iwashita; Susumu Shinoura; Do H Park; Jason B Samarasena; John G Lee; Kenneth J Chang Journal: Gastrointest Endosc Date: 2016-04-06 Impact factor: 9.427