Cystic neoplasms of the pancreas: results of 114 cases.
OBJECTIVE
To identify clinical, radiographic, and histopathologic characteristics associated with cancer in cystic pancreatic neoplasms and to evaluate our preoperative diagnostic accuracy to predict cancer in such cysts.


METHODS
Retrospective case series of 114 patients with cystic lesions of the pancreas who underwent resection between 1992 and 2006.


RESULTS
Eighty-nine patients (78%) had benign or premalignant cysts; 25 patients (22%) had malignant cysts (carcinoma in situ and/or an invasive cancer). The factors most predictive of malignancy were age (P = 0.03), presence of symptoms (P = 0.02), and a dilated pancreatic duct (P = 0.01). Of the symptoms recorded, weight loss (P = 0.01) and jaundice (P = 0.02) had the strongest correlation with malignancy. We correctly predicted the pathological diagnosis (benign vs malignant) for only 39 (67%) of the 58 patients where a preoperative diagnosis was clearly evident. Endoscopic ultrasound did not seem to improve our ability to preoperatively differentiate benign from malignant cysts (P > 0.05).


CONCLUSIONS
This series confirms that age, the presence of symptoms, and a dilated pancreatic duct on imaging are significantly associated with cancer in pancreatic cysts, and it highlights our inability to consistently make the preoperative diagnosis of cancer. Until more accurate markers of malignancy are available, an aggressive approach to management seems justified.
Donahue
Timothy R
TR
Division of General Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095-6904, USA.
Hines
O Joe
OJ
Farrell
James J
JJ
Tomlinson
James S
JS
Eibl
Guido
G
Reber
Howard A
HA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007565:Jaundice; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010181:Pancreatic Cyst / Q000175:diagnosis*; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015431:Weight Loss; D055815:Young Adult