Incidental pancreatic cysts: Do we really know what we are watching?

Camilo Correa-Gallego, Cristina R. Ferrone, Sarah P. Thayer, Jennifer A. Wargo, Andrew L. Warshaw, Carlos Fernández-Del Castillo

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

Background: Most cystic neoplasms of the pancreas (CNPs) are incidentally discovered. Their management continues to be debated and preoperative diagnosis is often inaccurate. Methods: Retrospective review of 330 patients with incidentally discovered CNPs. Preoperative and final histological diagnoses were correlated. Results: 41% (136/330) of patients were operated on at diagnosis. 50 patients underwent resection for a presumed branch-duct (Bd) intraductal papillary mucinous neoplasm (IPMN), which was confirmed in only 64% (32/50); of the remaining patients, 20% had main-duct involvement. Mucinous cystic neoplasm was the preoperative diagnosis in 30/136 patients, histologic examination was confirmatory in only 60% (18/30). Most lesions presumed to be main-duct or combined IPMNs or serous cystadenomas were confirmed as such after resection (15/16 and 11/12, respectively). Multifocality was not only associated with Bd-IPMN, and 5% of all cysts were non-neoplastic. Overall, in only 68% of cases did the preoperative and histological diagnoses match. Conclusions: In an experienced, high-volume center, preoperative diagnosis was incorrect in one-third of incidentally discovered CNPs who underwent resection. Of particular concern, 20% of presumed Bd-IPMN had a main-duct component. Conversely, 5% of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.

Original languageEnglish (US)
Pages (from-to)144-150
Number of pages7
JournalPancreatology
Volume10
Issue number2-3
DOIs
StatePublished - Jun 2010

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Pancreatic Cyst
Pancreatic Neoplasms
Cysts
Neoplasms
Serous Cystadenoma

Keywords

  • Branch-duct IPMNs
  • Cystic neoplasms
  • Incidental pancreatic cysts
  • Intraductal papillary mucinous neoplasms
  • Main-duct IPMNs
  • Mucinous cystic neoplasms
  • Pancreas, cystic neoplasms
  • Pancreatic cysts

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Cite this

Correa-Gallego, C., Ferrone, C. R., Thayer, S. P., Wargo, J. A., Warshaw, A. L., & Fernández-Del Castillo, C. (2010). Incidental pancreatic cysts: Do we really know what we are watching? Pancreatology, 10(2-3), 144-150. https://doi.org/10.1159/000243733

Incidental pancreatic cysts : Do we really know what we are watching? / Correa-Gallego, Camilo; Ferrone, Cristina R.; Thayer, Sarah P.; Wargo, Jennifer A.; Warshaw, Andrew L.; Fernández-Del Castillo, Carlos.

In: Pancreatology, Vol. 10, No. 2-3, 06.2010, p. 144-150.

Research output: Contribution to journalArticle

Correa-Gallego, C, Ferrone, CR, Thayer, SP, Wargo, JA, Warshaw, AL & Fernández-Del Castillo, C 2010, 'Incidental pancreatic cysts: Do we really know what we are watching?', Pancreatology, vol. 10, no. 2-3, pp. 144-150. https://doi.org/10.1159/000243733
Correa-Gallego C, Ferrone CR, Thayer SP, Wargo JA, Warshaw AL, Fernández-Del Castillo C. Incidental pancreatic cysts: Do we really know what we are watching? Pancreatology. 2010 Jun;10(2-3):144-150. https://doi.org/10.1159/000243733
Correa-Gallego, Camilo ; Ferrone, Cristina R. ; Thayer, Sarah P. ; Wargo, Jennifer A. ; Warshaw, Andrew L. ; Fernández-Del Castillo, Carlos. / Incidental pancreatic cysts : Do we really know what we are watching?. In: Pancreatology. 2010 ; Vol. 10, No. 2-3. pp. 144-150.
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abstract = "Background: Most cystic neoplasms of the pancreas (CNPs) are incidentally discovered. Their management continues to be debated and preoperative diagnosis is often inaccurate. Methods: Retrospective review of 330 patients with incidentally discovered CNPs. Preoperative and final histological diagnoses were correlated. Results: 41{\%} (136/330) of patients were operated on at diagnosis. 50 patients underwent resection for a presumed branch-duct (Bd) intraductal papillary mucinous neoplasm (IPMN), which was confirmed in only 64{\%} (32/50); of the remaining patients, 20{\%} had main-duct involvement. Mucinous cystic neoplasm was the preoperative diagnosis in 30/136 patients, histologic examination was confirmatory in only 60{\%} (18/30). Most lesions presumed to be main-duct or combined IPMNs or serous cystadenomas were confirmed as such after resection (15/16 and 11/12, respectively). Multifocality was not only associated with Bd-IPMN, and 5{\%} of all cysts were non-neoplastic. Overall, in only 68{\%} of cases did the preoperative and histological diagnoses match. Conclusions: In an experienced, high-volume center, preoperative diagnosis was incorrect in one-third of incidentally discovered CNPs who underwent resection. Of particular concern, 20{\%} of presumed Bd-IPMN had a main-duct component. Conversely, 5{\%} of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.",
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AU - Warshaw, Andrew L.

AU - Fernández-Del Castillo, Carlos

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N2 - Background: Most cystic neoplasms of the pancreas (CNPs) are incidentally discovered. Their management continues to be debated and preoperative diagnosis is often inaccurate. Methods: Retrospective review of 330 patients with incidentally discovered CNPs. Preoperative and final histological diagnoses were correlated. Results: 41% (136/330) of patients were operated on at diagnosis. 50 patients underwent resection for a presumed branch-duct (Bd) intraductal papillary mucinous neoplasm (IPMN), which was confirmed in only 64% (32/50); of the remaining patients, 20% had main-duct involvement. Mucinous cystic neoplasm was the preoperative diagnosis in 30/136 patients, histologic examination was confirmatory in only 60% (18/30). Most lesions presumed to be main-duct or combined IPMNs or serous cystadenomas were confirmed as such after resection (15/16 and 11/12, respectively). Multifocality was not only associated with Bd-IPMN, and 5% of all cysts were non-neoplastic. Overall, in only 68% of cases did the preoperative and histological diagnoses match. Conclusions: In an experienced, high-volume center, preoperative diagnosis was incorrect in one-third of incidentally discovered CNPs who underwent resection. Of particular concern, 20% of presumed Bd-IPMN had a main-duct component. Conversely, 5% of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.

AB - Background: Most cystic neoplasms of the pancreas (CNPs) are incidentally discovered. Their management continues to be debated and preoperative diagnosis is often inaccurate. Methods: Retrospective review of 330 patients with incidentally discovered CNPs. Preoperative and final histological diagnoses were correlated. Results: 41% (136/330) of patients were operated on at diagnosis. 50 patients underwent resection for a presumed branch-duct (Bd) intraductal papillary mucinous neoplasm (IPMN), which was confirmed in only 64% (32/50); of the remaining patients, 20% had main-duct involvement. Mucinous cystic neoplasm was the preoperative diagnosis in 30/136 patients, histologic examination was confirmatory in only 60% (18/30). Most lesions presumed to be main-duct or combined IPMNs or serous cystadenomas were confirmed as such after resection (15/16 and 11/12, respectively). Multifocality was not only associated with Bd-IPMN, and 5% of all cysts were non-neoplastic. Overall, in only 68% of cases did the preoperative and histological diagnoses match. Conclusions: In an experienced, high-volume center, preoperative diagnosis was incorrect in one-third of incidentally discovered CNPs who underwent resection. Of particular concern, 20% of presumed Bd-IPMN had a main-duct component. Conversely, 5% of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.

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