title: Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients.
abstract: OBJECTIVE
  The preoperative diagnosis between serous cystadenomas (SCAs) and mucinous cystadenomas (MCAs) in pancreas is significant due to their completely different biological behaviors. The purpose of our study was to examine and compare detailed contrast-enhanced ultrasonography (CEUS) images of SCAs and MCAs and to determine whether there are significant findings that can contribute to the discrimination between these two diseases.
  
  
  METHODS
  From April 2015 to June 2016, 61 patients (35 patients with SCAs and 26 patients with MCAs) were enrolled in this study. Forty-three cases were confirmed by surgical pathology and 18 by comprehensive clinical diagnoses. All of the CEUS characteristics of these lesions were recorded: size, location, echogenicity, shape, wall characteristics, septa characteristics, and the presence of a honeycomb pattern or nodules. CEUS examinations were performed by two ultrasound physicians.
  
  
  RESULTS
  Location (P=0.003), shape (P=0.000), thickness of the wall (P=0.005), the number of septa (P=0.001), and the honeycomb pattern (P=0.001) were statistically significantly different. A head-neck location, a lobulated shape, an inner regular honeycomb pattern, and a thin wall (<3 mm thick) were significant in diagnosing patients with SCAs. When two of these four findings were combined, we could achieve a sensitivity of 71.4% and a specificity of 80.8% to diagnose SCA; when three of these four findings were combined, the specificity was 100%. A body-tail location, a round/oval shape, 0-2 septa, and a thick wall (≥3 mm thick) were most often detected in patients with MCAs. When two of these four findings were combined, we could achieve a sensitivity of 88.5% and a specificity of 65.7% to diagnose MCA; when three of these four findings were combined, the area under the curve (Az) was highest at 0.832, with a sensitivity of 80.8% and a specificity of 85.7%.
  
  
  CONCLUSIONS
  The characteristics of tumor location, shape, thickness of the wall, the number of septa, and the honeycomb pattern by CEUS play an important role in the diagnosis of SCAs and MCAs. A combination of these findings can provide better diagnostic performance in the discrimination of SCAs from MCAs.
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Ya
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Fubo
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Fangyi
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Shuilian
authors.initials: S
authors.lastname: Tan
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Ping
authors.initials: P
authors.lastname: Liang
authors.affiliation: Department of Gastroenterology, Chinese PLA General Hospital, Beijing, People's Republic of China.
authors.forename: Enqiang
authors.initials: E
authors.lastname: Linghu
authors.affiliation: Department of Interventional Ultrasound.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Yu
keywords: contrast-enhanced sonography; diagnosis; mucinous cystadenoma; pancreatic cystic tumor; serous cystadenoma; ultrasound