Skip to main content
Log in

Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas

Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

A retrospective consecutive series of patients undergoing surgery for PCNs at Karolinska University Hospital between 2004 and 2012 was analyzed.

Results

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 %).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ip IK, Mortele KJ, Prevedello LM, et al. Focal cystic pancreatic lesions: assessing variation in radiologists management recommendations. Radiology. 2011;259:136–41.

    Article  PubMed  Google Scholar 

  3. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191:802–7.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: detection on single-shot fast spin-echo MR images. Radiology. 2002;223:547–53.

    Article  PubMed  Google Scholar 

  5. 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.

    Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. Donahue TR, Hines OJ, Farrell JJ. Cystic neoplasms of the pancreas: results of 114 cases. Pancreas. 2010;39:1271–6.

    Article  PubMed  Google Scholar 

  11. Bosman F, Carneiro F, Hruban R, Theise N, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC Press; 2010.

    Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    PubMed Central  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. Tipton SG, Smyrk TC, Sarr MG, et al. Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg. 2006;93:733–7.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Ryu JK, Woo SM, Hwang JH, et al. Cyst fluid analysis for the differential diagnosis of pancreatic cysts. Diagn Cytopathol. 2004;31:100–5.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    PubMed Central  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marco Del Chiaro MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Del Chiaro, M., Segersvärd, R., Pozzi Mucelli, R. et al. Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas. Ann Surg Oncol 21, 1539–1544 (2014). https://doi.org/10.1245/s10434-013-3465-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3465-9

Keywords

Navigation