Wenchuan Wu1, Ji Li2, Ning Pu1, Gang Li3, Xin Wang4, Gang Zhao5, Lei Wang6, Xiaodong Tian7, Chunhui Yuan8, Yi Miao9, Kuirong Jiang9, Jun Cao10, Xiaowu Xu11, Xueli Bai12, Yongsheng Yang13, Fubao Liu14, Xuewei Bai15, Rui Kong15, Zheng Wang16, Deliang Fu2, Wenhui Lou1. 1. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. 2. Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China. 3. Department of General Surgery, Changhai Hospital, Naval Medicine University, Shanghai 200433, China. 4. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. 5. Department of General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. 6. Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China. 7. Department of General Surgery, Peking University First Hospital, Beijing 100034, China. 8. Department of General Surgery, Peking University Third Hospital, Beijing 100191, China. 9. Pancreatic Center & Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China. 10. Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. 11. Department of General Surgery, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou 310014, China. 12. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China. 13. Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun 130022, China. 14. Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China. 15. Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China. 16. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Abstract
BACKGROUND: Serous cystic neoplasms (SCN) rarely have malignant potential, so accurate diagnosis of SCN is crucial for proper clinical management, especially to avoid unnecessary surgeries. However, the misdiagnosis of other pancreatic cystic neoplasm instead of SCN may highly increase the risk of malignancy in patients who receive no surgery. METHODS: Data from a total of 678 patients with pathologically confirmed to have SCN at sixteen institutions in China from January 1st, 2006 to December 31st, 2016 were retrieved to evaluate the malignancy risk of SCN. RESULTS: Among the 678 patients confirmed to have SCN with postoperative pathologic analysis, 649 patients (95.7%) had only one lesion and the average maximum diameter was 3.8±2.47 cm. Four patients were pathologically verified as having serous cystadenocarcinoma, so the SCN actual malignancy rate was 0.6%, while the mortality due to pancreatic surgery in these high-volume centers was nearly 0.2-2%. However, among the 99 SCN patients based on preoperative radiology, three were confirmed to have intraductal papillary mucinous neoplasms (IPMN), nine as mucinous cystic neoplasms (MCN), and four as solid pseudopapillary tumors (SPT) after postoperative pathological analysis. Thus, the total theoretical malignancy rate resulting from preoperative misdiagnosis was elevated to approximately 2.9%, higher than the risk of perioperative mortality. CONCLUSIONS: When SCN can't be accurately distinguished from cystic tumors of pancreas, the malignant risk of cystic tumors may be higher than perioperative risk. However, if it can be diagnosed as SCN accurately, surgery can be avoided as well. 2019 Annals of Translational Medicine. All rights reserved.
BACKGROUND: Serous cystic neoplasms (SCN) rarely have malignant potential, so accurate diagnosis of SCN is crucial for proper clinical management, especially to avoid unnecessary surgeries. However, the misdiagnosis of other pancreatic cystic neoplasm instead of SCN may highly increase the risk of malignancy in patients who receive no surgery. METHODS: Data from a total of 678 patients with pathologically confirmed to have SCN at sixteen institutions in China from January 1st, 2006 to December 31st, 2016 were retrieved to evaluate the malignancy risk of SCN. RESULTS: Among the 678 patients confirmed to have SCN with postoperative pathologic analysis, 649 patients (95.7%) had only one lesion and the average maximum diameter was 3.8±2.47 cm. Four patients were pathologically verified as having serous cystadenocarcinoma, so the SCN actual malignancy rate was 0.6%, while the mortality due to pancreatic surgery in these high-volume centers was nearly 0.2-2%. However, among the 99 SCN patients based on preoperative radiology, three were confirmed to have intraductal papillary mucinous neoplasms (IPMN), nine as mucinous cystic neoplasms (MCN), and four as solid pseudopapillary tumors (SPT) after postoperative pathological analysis. Thus, the total theoretical malignancy rate resulting from preoperative misdiagnosis was elevated to approximately 2.9%, higher than the risk of perioperative mortality. CONCLUSIONS: When SCN can't be accurately distinguished from cystic tumors of pancreas, the malignant risk of cystic tumors may be higher than perioperative risk. However, if it can be diagnosed as SCN accurately, surgery can be avoided as well. 2019 Annals of Translational Medicine. All rights reserved.
Authors: Nakul P Valsangkar; Vicente Morales-Oyarvide; Sarah P Thayer; Cristina R Ferrone; Jennifer A Wargo; Andrew L Warshaw; Carlos Fernández-del Castillo Journal: Surgery Date: 2012-07-06 Impact factor: 3.982
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