title: Analysis of cyst size and tumor markers in the management of pancreatic cysts: support for the original Sendai criteria.
abstract: BACKGROUND
  In 2006, the Sendai Consensus Guidelines identified size >3.0 cm as the only independent predictor of malignancy in incidentally discovered pancreatic cysts. The 2012 updated guidelines increased emphasis on radiographic features over size. Earlier studies included patients with preoperatively diagnosed carcinoma or with a corresponding mass. In this report, we characterize the use of size and serum tumor markers in the initial evaluation of pancreatic cystic neoplasms without preoperatively diagnosed adenocarcinoma and correlate them with clinical and pathologic outcomes.
  
  
  METHODS
  A retrospective cohort study was undertaken of 112 patients with a resected pancreatic cystic neoplasm. Patient demographics, cyst characteristics, preoperative serum tumor markers, morbidity, and mortality were captured. Statistical analysis included nonparametric tests of comparison, multivariate logistic regression, and receiver operating characteristic curve analyses.
  
  
  RESULTS
  One hundred and twelve pancreatic cystic neoplasms were resected; there was one perioperative death. Mucinous cysts were common (78%), followed by serous cysts (13%). In total, 17% of cysts harbored malignancy. On multivariate analysis, the risk of malignancy in cysts≥3 cm was more than 4 times that of smaller cysts (relative risk (RR)=4.32; 95% CI, 1.55-12.07). There was no significant difference in serum CEA, cancer antigen 19-9, or cyst-fluid CEA levels between the benign and malignant groups. At a median follow-up of 30 months, the incidence of diabetes was 15%.
  
  
  CONCLUSIONS
  Surgical resection of pancreatic cysts can be performed with low perioperative mortality and acceptable long-term morbidity. Use of cyst size as a rationale for resection of cystic lesion, as per the Sendai criteria, is justified.
authors: Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA. Electronic address: Rebecca.hoffman@uphs.upenn.edu.
authors: Rebecca L
authors: RL
authors: Hoffman
authors: Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Jenna L
authors: JL
authors: Gates
authors: Department of Gastroenterology, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Michael L
authors: ML
authors: Kochman
authors: Department of Gastroenterology, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Gregory G
authors: GG
authors: Ginsberg
authors: Department of Gastroenterology, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Nuzhat A
authors: NA
authors: Ahmad
authors: Department of Gastroenterology, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Vinay
authors: V
authors: Chandrasekhara
authors: Pathology and Laboratory Medicine, Anatomic Pathology Division, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Emma E
authors: EE
authors: Furth
authors: Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Charles M
authors: CM
authors: Vollmer
authors: Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
authors: Jeffrey A
authors: JA
authors: Drebin
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010181:Pancreatic Cyst / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor