Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas
Diagnostic errors in the evaluation of cystic neoplasms of the pancreas (PCNs) are quite common. Few data are available regarding the impact of these errors on clinical management. The aim of this study was to determine the accuracy of a pancreatic multidisciplinary conference in diagnosing PCNs, to assess the potential risk of misdiagnosis, and to evaluate the clinical impact of these errors.
A retrospective consecutive series of patients undergoing surgery for PCNs at Karolinska University Hospital between 2004 and 2012 was analyzed.
During the study period, a total of 141 patients had undergone pancreatic resection for PCN. The overall accuracy of the preoperative diagnosis was 60.9 %. The rate of concordance between preoperative diagnosis and histology was similar for asymptomatic and symptomatic lesions (62.8 vs. 59.1 %; p = NS). The rate of correct diagnosis increased over time (54.5 % in 2004–2006, 61.7 % in 2007–2012, 63.5 % in 2010–2012). Univariate analysis identified the location of the lesion (diffuse pancreatic involvement) and a mucinous nature of the lesion as factors conducive to a correct diagnosis. Reevaluation of the original indication for surgery in light of the exact diagnosis showed that a surgical procedure should not have been performed in 12 patients (8.5 %).
This study confirms that diagnostic errors are fairly common in the preoperative assessment of PCNs, but the errors are clinically relevant in <10 % of patients.
- Correa-Gallego C, Ferrone CR, Thayer SP, et al. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology. 2010;10:144–50. CrossRef
- Ip IK, Mortele KJ, Prevedello LM, et al. Focal cystic pancreatic lesions: assessing variation in radiologists management recommendations. Radiology. 2011;259:136–41. CrossRef
- Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191:802–7. CrossRef
- Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: detection on single-shot fast spin-echo MR images. Radiology. 2002;223:547–53. CrossRef
- Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus steatment on cystic tumors of the pancreas. Dig Liver Dis. 2013;45(9):703–11.
- Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97. CrossRef
- Cho CS, Russ AJ, Loeffler AG, et al. Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol. 2013;20(9):3112–9.
- Salvia R, Malleo G, Marchegiani G, et al. Pancreatic resections for cystic neoplasm: from the surgeon’s presumption to the pathologist’s reality. Surgery. 2012;152:S135–42. CrossRef
- Leung KK, Ross WA, Evans D, et al. Pancreatic cystic neoplasm: the role of cyst morphology, cyst fluid analysis, and expectant management. Ann Surg Oncol. 2009;16:2818–24. CrossRef
- Donahue TR, Hines OJ, Farrell JJ. Cystic neoplasms of the pancreas: results of 114 cases. Pancreas. 2010;39:1271–6. CrossRef
- Bosman F, Carneiro F, Hruban R, Theise N, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC Press; 2010.
- Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32. CrossRef
- Tseng JF, Warshaw AL, Sahani DV, et al. Serous cystadenoma of the pancreas: tumor grow rates and recommendations for treatment. Ann Surg. 2005;242:413–9.
- Malleo G, Bassi C, Rossini R, et al. 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. CrossRef
- Tipton SG, Smyrk TC, Sarr MG, et al. Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg. 2006;93:733–7. CrossRef
- Allen PJ, Jaques DP, D’Angelica M, et al. Cystic lesions of the pancreas: selection criteria for operative and nonoperative management in 209 patients. J Gastrointest Surg. 2003;7:970–7. CrossRef
- Ryu JK, Woo SM, Hwang JH, et al. Cyst fluid analysis for the differential diagnosis of pancreatic cysts. Diagn Cytopathol. 2004;31:100–5. CrossRef
- Jang JY, Kim SW, Lee SE, et al. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol. 2008;15:199–205. CrossRef
- Allen PJ, D’Angelica M, Gonen M, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572–82.
- Ahmad NA, Kochman ML, Bernsinger C, et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc. 2003;58:59–64. CrossRef
- Cizniger S, Turner B, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas. 2011;40:1024–8. CrossRef
- Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas
Annals of Surgical Oncology
Volume 21, Issue 5 , pp 1539-1544
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- 2. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- 3. Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden