title: Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions.
abstract: OBJECTIVE
  Pancreatic mucinous cystic neoplasms (MCN) are premalignant lesions whose natural history is poorly known. Whether the dysplasia grade might be determined with precision by preoperative clinical and imaging criteria is not known. We aimed to determine if CT scan data might be useful to predict the grade of dysplasia in a series of 60 histologically proven MCN.
  
  
  METHODS
  All consecutive patients who were operated on with pathological confirmation of MCN were included. Careful CT scan evaluation was reviewed without knowledge of pathological results. Imaging and pathological results were correlated.
  
  
  RESULTS
  Sixty patients (59 females) were included. Low- and intermediate-grade dysplasias were identified in 47 and 3 patients (benign MCN), respectively, and high-grade dysplasia and invasive carcinoma in 7 and 3 patients (malignant MCN), respectively. Patients with benign lesions were significantly younger. None of the studied clinical data were statistically different to distinguish benign and malignant MCN, except age (42 vs. 48 years, p < 0.05). Only maximal diameter and mural nodules on CT scan were significantly more frequent in the malignant group. No malignant MCN had a maximal diameter <40 mm. At a 40-mm threshold, the sensitivity and specificity of the maximal diameter to diagnose malignant MCN were 100 and 54%, respectively. Mural nodules seen on CT scan were confirmed in all cases but one upon pathological examination of the surgical specimen. The sensitivity and specificity of the presence of a mural nodule seen on CT scan for the diagnosis of a malignant lesion were 100 and 98%, respectively.
  
  
  CONCLUSIONS
  Preoperative CT scan detection of a mural nodule within a cystic pancreatic neoplasm suggestive of MCN strongly suggests malignancy. A diameter <40 mm is associated with no risk of malignancy.
authors: Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France.
authors: Yann
authors: Y
authors: Le Baleur
authors: Anne
authors: A
authors: Couvelard
authors: Marie Pierre
authors: MP
authors: Vullierme
authors: Alain
authors: A
authors: Sauvanet
authors: Pascal
authors: P
authors: Hammel
authors: Vinciane
authors: V
authors: Rebours
authors: Frédérique
authors: F
authors: Maire
authors: Olivia
authors: O
authors: Hentic
authors: Alain
authors: A
authors: Aubert
authors: Philippe
authors: P
authors: Ruszniewski
authors: Philippe
authors: P
authors: Lévy
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018291:Cystadenoma, Mucinous / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed