title: Is there an indication for initial conservative management of pancreatic cystic lesions?
abstract: BACKGROUND
  The management of small pancreatic cystic lesions presents a clinical challenge.
  
  
  METHODS
  We reviewed our experience with 78 patients who presented with a cystic pancreatic lesion who underwent operative management between 1995 and 2005. Data on cyst characteristics were analyzed in the context of pathologic findings following resection.
  
  
  RESULTS
  Among 78 patients, there were 55 (71%) females; median age 63 years. Patients presented with: an incidental finding (48%), pain (40%), acute pancreatitis (4%), other (8%). Operations were distal pancreatectomy (n = 47), pancreaticoduodenectomy (n = 16), and other (n = 15). Most patients had a non-malignant lesion (n = 65, 83%) (mucinous cystadenoma (n = 29), serous cystadenoma (n = 15), IPMN without invasion (n = 8), pseudocyst (n = 8), other benign (n = 5)). Malignant lesions (adenocarcinoma, neuroendocrine tumor, and other) were found in 13 patients (17%). The risk of malignancy increased with size: <3 cm (n = 25), 4%; 3-5 cm (n = 23), 13%; and >5 cm (n = 30), 30%. Pre-operative cyst fluid cytology was performed in 41 patients. The negative predictive value (NPV) of cytology for malignancy was 88% and the positive predictive value (PPV) was 80%. The NPV of CA 19-9 for malignancy was 90%; the PPV was 50%.
  
  
  CONCLUSIONS
  Initial conservative management of small cystic pancreatic lesions may be indicated in selected patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA. stephen.grobmyer@surgery.ufl.edu
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: William G
authors.initials: WG
authors.lastname: Cance
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Vogel
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003537:Cystadenoma / Q000097:blood / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen