P Duconseil1, O Turrini2, J Ewald2, J Soussan3, A Sarran4, M Gasmi5, V Moutardier1, J R Delpero2. 1. Department of Digestive Surgery, Hôpital Nord, Marseille, France. 2. Department of Surgical Oncology, Hôpital Nord, Marseille, France. 3. Department of Radiology, Hôpital Nord, Marseille, France. 4. Department of Radiology, Institut Paoli-Calmettes, Hôpital Nord, Marseille, France. 5. Department of Endoscopy, Hôpital Nord, Marseille, France.
Abstract
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.
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.
Authors: Olivier Turrini; C Max Schmidt; Henry A Pitt; Jerome Guiramand; Juan R Aguilar-Saavedra; Shadi Aboudi; Keith D Lillemoe; Jean Robert Delpero Journal: HPB (Oxford) Date: 2011-02 Impact factor: 3.647
Authors: M Siech; K Tripp; B Schmidt-Rohlfing; T Mattfeldt; U Widmaier; F Gansauge; J Görich; H G Beger Journal: Langenbecks Arch Surg Date: 1998-03 Impact factor: 3.445
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: Koen de Jong; Jeanin E van Hooft; C Yung Nio; Dirk J Gouma; Marcel G W Dijkgraaf; Marco J Bruno; Paul Fockens Journal: Scand J Gastroenterol Date: 2012-05-10 Impact factor: 2.423
Authors: M Al-Haddad; M B Wallace; T A Woodward; S A Gross; C M Hodgens; R D Toton; M Raimondo Journal: Endoscopy Date: 2007-12-04 Impact factor: 10.093