title: Cystic lesions of the pancreas-is radical surgery really warranted?
abstract: OBJECTIVE
  The purpose of this study was to retrospectively evaluate diagnostic accuracy of cystic lesions of the pancreas in order to determine if less aggressive surgical treatment might be safe and therefore warranted.
  
  
  METHODS
  A retrospective cohort study was conducted in 232 patients with either observed or resected cystic lesions of the pancreas referred for evaluation and treatment to the University Medical Center Freiburg, Germany, between 2001 and 2011.
  
  
  RESULTS
  Most patients had MRI or CT for preoperative imaging (90.6 %). Preoperatively, benign pseudocysts (BPC) were diagnosed in 84 (36.2 %) patients and intraductal papillary mucinous neoplasm (IPMN) in 59 (25.2 %) patients, whereas serous cyst adenoma, mucinous cystic neoplasm (MCN), solid pseudopapillary tumors (SPPTs), and neuroendocrine tumors (NETs) were less common. In 43 % of patients, the preoperative diagnosis concurred with the postoperative diagnosis. The preoperative diagnosis was accurate in BPC, less so in IPMN, and inaccurate in MCN, NET, and SPPT. However, prediction of tumor biology was accurate; only 11 % of the lesions regarded as benign turned out to be malignant after resection, and no patient without resection developed malignancy at a median follow-up of 8 months. Subsequently, 89 % of diagnosed benign tumors had indeed benign pathology.
  
  
  CONCLUSIONS
  The prediction of biology is often correct, whereas specific diagnosis is often wrong. A considerable amount of benign lesions are treated more aggressively than warranted if malignancy is suspected prior to surgery. Parenchyma-sparing techniques might be an option, but prospective multicenter studies need to follow. Experienced pancreatic radiologists can improve accuracy of preoperative biology.
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Kim C
authors.initials: KC
authors.lastname: Honselmann
authors.affiliation: Department of Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Krauss
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Geserick
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Ulrich F
authors.initials: UF
authors.lastname: Wellner
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Wittel
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany. dirk.bausch@uksh.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bausch
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: IPMN; Pancreatic cystic lesions; Parenchyma sparing surgery; Preoperative imaging