title: Prospective preoperative determination of mucinous pancreatic cystic neoplasms.
abstract: 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.affiliation: Departments of General Surgery, Diagnostic Radiology, Gastroenterology, and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: J Michael
authors.initials: JM
authors.lastname: Henderson
authors.forename: David P
authors.initials: DP
authors.lastname: Vogt
authors.forename: Mark E
authors.initials: ME
authors.lastname: Baker
authors.forename: Charles M
authors.initials: CM
authors.lastname: O'malley
authors.forename: Brian
authors.initials: B
authors.lastname: Herts
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: John A
authors.initials: JA
authors.lastname: Dumot
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.forename: Charles V
authors.initials: CV
authors.lastname: Biscotti
authors.forename: Nancy
authors.initials: N
authors.lastname: Brown
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000145:classification / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors