Prospective preoperative determination of mucinous pancreatic cystic neoplasms

• Published in: Surgery 2002-10, Vol.132 (4), p.628-634
• Main Authors: Walsh, R.Matthew, Henderson, J.Michael, Vogt, David P., Baker, Mark E., O'Malley, Charles M., Herts, Brian, Zuccaro, Gregory, Vargo, John J., Dumot, John A., Conwell, Darwin L., Biscotti, Charles V., Brown, Nancy
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Mucinous - classification; Adenocarcinoma, Mucinous - diagnosis; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous - diagnosis; Neoplasms, Cystic, Mucinous, and Serous - pathology; Neoplasms, Cystic, Mucinous, and Serous - surgery; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - surgery; Retrospective Studies; Time Factors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1067/msy.2002.127543

Background. Optimal management of pancreatic cystic neoplasms includes identification and resection of mucinous neoplasms. This study was performed to assess the accuracy of preoperative variables in determining a mucinous lesion. Methods. Patients referred for a cystic neoplasm were prospectively assessed by presenting symptoms, blinded radiologic review, and endoscopic ultrasound-guided cyst aspirate analysis. Patients who were symptomatic, or had aspirate findings of a mucinous neoplasm were resected. Results. Eighty-seven patients were enrolled over a 22-month period ending in December 2001. There were 56 (64%) women and 31 (36%) men, with a mean age of 63 (27-86) years. Thirty-five (40%) patients were resected including 24 (69%) women and 11 (31%) men with a mean age of 58 years. Twenty-eight (80%) patients who had resection were symptomatic. Specimen histology included 18 (51%) mucinous neoplasms, 8 (23%) serous neoplasms, 4 (11%) ductal or neuroendocrine carcinomas, and 3 (9%) pseudocysts. The positive predictive value (PPV) for cyst-aspirate extracellular mucin (83%) was significant in predicting a mucinous neoplasm (P =.009). No other aspirate variables (amylase, carcinoembryonic antigen, CA15-3, viscosity), or patient characteristics were predictive of final histology. Diagnostic agreement between all 3 radiologists was 8% (P =.98). At a median follow-up of 12 months, no patients who were observed required resection. Conclusions. Patients with suspected pancreatic cystic neoplasms can be selectively treated on the basis of symptoms and cyst-aspirate mucin analysis. Symptomatic and mucin containing lesions should be resected. Surgery 2002;132:628-34.