Clinicoradiological Features of Resected Serous Cystic Neoplasms According to Morphological Subtype and Preoperative Tentative Diagnosis: Can Radiological Characteristics Distinguish Serous Cystic Neoplasms from Other Lesions?

Overview

Journal Ann Surg Treat Res

Specialty General Surgery

Date 2020 May 16

PMID 32411629

Citations 5

Authors

Jae Seung Kang

Hyo Jun Kim

Yoo Jin Choi

Yoonhyeong Byun

Jeong Min Lee

Youngmin Han

Hongbeom Kim

Wooil Kwon

Jin-Young Jang

Affiliations

Soon will be listed here.

Abstract

Purpose: Serous cystic neoplasm (SCN) of the pancreas is considered benign in most cases. However, some SCN patients undergo surgical resection because lesions could not be differentiated preoperatively. This study evaluated causes of resection for SCN, investigated clinical and radiological features of surgically resected SCNs, and compared characteristics of SCNs diagnosed accurately and those misdiagnosed.

Methods: One hundred patients, who underwent surgery for pancreatic cystic tumors with pathological confirmation of SCN between 2000 and 2014 were retrospectively analyzed.

Results: The mean patient age was 52.9 years, 67 (67%) were female, and most lesions (72%) were located in the pancreatic body or tail. Fifty-one (51%) pathologically confirmed SCNs were preoperatively diagnosed as non-SCNs. Patients underwent surgery due to uncertain diagnosis (58%) or symptomatology (18%). According to radiological examination, most lesions were macrocystic (85%), exhibited septation (58%), or were enhancing lesions (48%). Compared with preoperatively diagnosed non-SCNs, accurately diagnosed SCNs exhibited septation (75.5% 41.2%, P = 0.001) and central scar (36.7% 11.8%, P = 0.003) more frequently in radiological examinations. In terms of macrocystic tumors (n = 85), most parameters did not differentiate preoperative diagnoses, although lesions accurately diagnosed as SCN exhibited septation more frequently than those preoperatively misdiagnosed as mucinous cystic neoplasm or intraductal papillary mucinous neoplasm (70.7% 38.9% 33.3%, respectively, P = 0.009).

Conclusion: It is difficult to accurately distinguish macrocystic SCNs from other cystic tumors using conventional radiological methods. For more accurate diagnosis, new biomarkers and/or other diagnostic modalities are needed and warrant further investigation.

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References

Sakorafas G, Smyrniotis V, Reid-Lombardo K, Sarr M . Primary pancreatic cystic neoplasms revisited: part II. Mucinous cystic neoplasms. Surg Oncol. 2011; 20(2):e93-101. DOI: 10.1016/j.suronc.2010.12.003. View

Matsumoto T, Hirano S, Yada K, Shibata K, Sasaki A, Kamimura T . Malignant serous cystic neoplasm of the pancreas: report of a case and review of the literature. J Clin Gastroenterol. 2005; 39(3):253-6. DOI: 10.1097/01.mcg.0000152749.64526.38. View

Tseng J, Warshaw A, Sahani D, Lauwers G, Rattner D, Fernandez-Del Castillo C . Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg. 2005; 242(3):413-9. PMC: 1357749. DOI: 10.1097/01.sla.0000179651.21193.2c. View

Bjork Werner J, Bartosch-Harlid A, Andersson R . Cystic pancreatic lesions: current evidence for diagnosis and treatment. Scand J Gastroenterol. 2011; 46(7-8):773-88. DOI: 10.3109/00365521.2011.551892. View

King J, Ng T, White S, Cortina G, Reber H, Hines O . Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg. 2009; 13(10):1864-8. PMC: 2759006. DOI: 10.1007/s11605-009-0926-3. View

Brugge W, Lauwers G, Sahani D, Fernandez-Del Castillo C, Warshaw A . Cystic neoplasms of the pancreas. N Engl J Med. 2004; 351(12):1218-26. DOI: 10.1056/NEJMra031623. View

Malleo G, Bassi C, Rossini R, Manfredi R, Butturini G, Massignani M . Growth pattern of serous cystic neoplasms of the pancreas: observational study with long-term magnetic resonance surveillance and recommendations for treatment. Gut. 2011; 61(5):746-51. DOI: 10.1136/gutjnl-2011-300297. View

Li Z, Li Q . [The latest 2010 WHO classification of tumors of digestive system]. Zhonghua Bing Li Xue Za Zhi. 2011; 40(5):351-4. View

Strobel O, Zgraggen K, Schmitz-Winnenthal F, Friess H, Kappeler A, Zimmermann A . Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion. 2003; 68(1):24-33. DOI: 10.1159/000073222. View

10.

Butte J, Brennan M, Gonen M, Tang L, DAngelica M, Fong Y . Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg. 2010; 15(2):350-7. DOI: 10.1007/s11605-010-1337-1. View

11.

Sakorafas G, Smyrniotis V, Reid-Lombardo K, Sarr M . Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol. 2011; 20(2):e84-92. DOI: 10.1016/j.suronc.2010.12.002. View

12.

Zhang X, Yu Z, Zhao Y, Dai M . Current perspectives on pancreatic serous cystic neoplasms: Diagnosis, management and beyond. World J Gastrointest Surg. 2016; 8(3):202-11. PMC: 4807321. DOI: 10.4240/wjgs.v8.i3.202. View

13.

Hwang H, Kim H, Kang C, Lee W . Serous cyst adenoma of the pancreas: appraisal of active surgical strategy before it causes problems. Surg Endosc. 2011; 26(6):1560-5. PMC: 3351602. DOI: 10.1007/s00464-011-2070-x. View

14.

Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang J, Levy P, Ohtsuka T . Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17(5):738-753. DOI: 10.1016/j.pan.2017.07.007. View

15.

Lee S, Kwon Y, Jang J, Kim Y, Hwang D, Kim M . The morphological classification of a serous cystic tumor (SCT) of the pancreas and evaluation of the preoperative diagnostic accuracy of computed tomography. Ann Surg Oncol. 2008; 15(8):2089-95. DOI: 10.1245/s10434-008-9959-1. View

16.

Galanis C, Zamani A, Cameron J, Campbell K, Lillemoe K, Caparrelli D . Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment. J Gastrointest Surg. 2007; 11(7):820-6. DOI: 10.1007/s11605-007-0157-4. View

17.

Okano K, Hirao T, Unno M, Fujii T, Yoshitomi H, Suzuki S . Postoperative infectious complications after pancreatic resection. Br J Surg. 2015; 102(12):1551-60. DOI: 10.1002/bjs.9919. View

18.

Bassi C, Salvia R, Molinari E, Biasutti C, Falconi M, Pederzoli P . Management of 100 consecutive cases of pancreatic serous cystadenoma: wait for symptoms and see at imaging or vice versa?. World J Surg. 2003; 27(3):319-23. DOI: 10.1007/s00268-002-6570-7. View

19.

Hirooka Y, Goto H, Itoh A, Hashimoto S, Niwa K, Ishikawa H . Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003; 18(11):1323-4. DOI: 10.1046/j.1440-1746.2003.03040.x. View

20.

Fernandez-Del Castillo C, Targarona J, Thayer S, Rattner D, Brugge W, Warshaw A . Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003; 138(4):427-3; discussion 433-4. PMC: 4403874. DOI: 10.1001/archsurg.138.4.427. View