Natural history of indeterminate pancreatic cysts
- 31 October 2005
- journal article
- Published by Elsevier BV in Surgery
- Vol. 138 (4), 665-671
- https://doi.org/10.1016/j.surg.2005.07.019
Abstract
The optimal treatment for incidental asymptomatic pancreatic cysts is not known. The purpose of this study was to determine whether nonmucinous cysts by cyst-aspiration analysis can be observed safely. A prospective protocol was initiated in September of 1999 for all suspected cystic neoplasms. Asymptomatic patients with negative cyst aspirates (no extracellular mucin, and concentration of carcinoembryonic antigen in the cyst fluid <200 ng/mL) were followed-up clinically and radiographically. Through December 2004, 221 patients have been evaluated, and 80 (36%) initially were operated. There were 141 (64%) patients with indeterminate cysts, 98 have been followed-up for more than 12 months. Compared with resected patients, observed patients were older (62 vs 56 y, P < .006), and had smaller cysts (2.4 vs 4.0, P = .001). At a mean follow-up period of 24 months, 4 patients (4%) were resected. The indication, time to resection, and pathology were as follows: 2 patients for symptoms (abdominal pain and obstructive jaundice) at 24 and 72 months, respectively: mucinous and serous cystadenomas; 1 patient for an increase in size (6.6 to 7.8 cm) at 18 months: lymphoepithelial cyst; and 1 patient for abdominal pain and increase in size (2.0 to 3.7 cm) at 41 months: pseudocyst. The only patient resected for a mucinous neoplasm had a cyst fluid carcinoembryonic antigen level of 896 ng/mL. In the remaining observed patients, 20 (23%) showed a decrease in cyst size, and 16 (19%) showed an increase in size (mean diameter change, 21%). Initial follow-up evaluation indicates that asymptomatic patients without evidence of a mucinous neoplasm by cyst aspiration can be followed clinically and with interval imaging.Keywords
This publication has 28 references indexed in Scilit:
- Cyst fluid analysis for the differential diagnosis of pancreatic cystsDiagnostic Cytopathology, 2004
- Cystic Pancreatic NeoplasmsAnnals of Surgery, 2004
- Laparoscopic pancreatic surgery: Current indications and surgical resultsSurgical Endoscopy, 2004
- Fine-needle aspiration cytology of mucinous tumors of the pancreasCancer, 2004
- Surgery of cystic neoplasmsGastrointestinal Endoscopy Clinics of North America, 2002
- CYSTIC NEOPLASMS OF THE PANCREASSurgical Clinics of North America, 2001
- Cystic Tumors of the PancreasDigestive Diseases, 2001
- Detection of gastric mucins (M1 antigens) in cyst fluid for the diagnosis of cystic lesions of the pancreasInternational Journal of Cancer, 1997
- Expression of CA 72–4 (TAG-72) in the Fluid Contents of Pancreatic Cysts A New Marker to Distinguish Malignant Pancreatic Cystic Tumors from Benign Neoplasms and PseudocystsAnnals of Surgery, 1994
- Cyst Fluid Analysis in the Differential Diagnosis of Pancreatic Cysts A Comparison of Pseudocysts, Serous Cystadenomas, Mucinous Cystic Neoplasms, and Mucinous CystadenocarcinomaAnnals of Surgery, 1993