title: Pancreatic resections for cystic neoplasms: from the surgeon's presumption to the pathologist's reality.
abstract: BACKGROUND
  Current guidelines for the management of pancreatic cystic neoplasms are based on the assumption that these lesions can be classified correctly on the basis of features of cross-sectional imaging. However, a certain degree of overlap between different lesions exists, and little is known about the rate of inaccurate preoperative diagnoses. To address this issue, preoperative and final pathologic diagnoses of patients resected for a presumed pancreatic cystic neoplasm were compared.
  
  
  METHODS
  Retrospective analysis was undertaken of patients managed operatively between 2000 and 2010. Preoperative workup was reviewed to identify diagnostic pitfalls and potential risk factors for incorrect preoperative characterization of cystic lesions presumed to be neoplastic.
  
  
  RESULTS
  We analyzed 476 patients. Final pathologic diagnosis matched the preoperative diagnosis in 78% of cases. The highest accuracy was reached for solid pseudopapillary neoplasms (95%) and for main duct/mixed duct intraductal papillary mucinous neoplasms (81%). Surprisingly, 23 cysts (5%) were found to be ductal adenocarcinoma, whereas 45 patients (9%) underwent a pancreatic resection for a non-neoplastic condition. The use of a routine radiologic workup, including contrast-enhanced ultrasonography and magnetic resonance imaging, was associated with a favorably correct characterization of the cystic lesion. Endoscopic ultrasonography did not seem to improve diagnostic accuracy. Increased levels of serum carbohydrate antigen (CA)19-9 resulted as risk factors for an incorrect diagnosis as well as for a final diagnosis of a ductal adenocarcinoma.
  
  
  CONCLUSIONS
  The overall rate of inaccurate preoperative diagnoses in a tertiary care center with a broad experience in pancreatology approached 22%. Serum CA19-9 is an important complementary tool within the context of preoperative investigation of cystic neoplasms of the pancreas.
authors: Unit of General Surgery B, Pancreas Institute, G.B. Rossi Hospital, Department of Surgery, University of Verona Hospital Trust, Verona. Italy. salvia@ospedaleuniverona.it
authors: Roberto
authors: R
authors: Salvia
authors: Giuseppe
authors: G
authors: Malleo
authors: Giovanni
authors: G
authors: Marchegiani
authors: Silvia
authors: S
authors: Pennacchio
authors: Salvatore
authors: S
authors: Paiella
authors: Marina
authors: M
authors: Paini
authors: Antonio
authors: A
authors: Pea
authors: Giovanni
authors: G
authors: Butturini
authors: Paolo
authors: P
authors: Pederzoli
authors: Claudio
authors: C
authors: Bassi
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor