Clinical study of imaging and rapid pathology in diagnosis and treatment of pancreatic cystic neoplasm_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GONG Xinli ^1,2 , CHENG Kun ¹ , LIN Hai ¹ , SUN Yonghui ¹ ,  CHEN Qilong ¹

1. Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, P. R. China;
2. Department of Hepatobiliary, Pancreatic, and Spleen Surgery, Tongchuan People’s Hospital, Tongchuan, Shaanxi 727000, P. R. China;

Corresponding?author：

CHEN Qilong, Email: chenqilong651003@sohu.com

Keywords：

pancreatic cystic neoplasm; diagnosis; preoperative imaging examination; intraoperative rapid pathological examination

DOI：

10.7507/1007-9424.201905096

Video：

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Objective To investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm (PCN).Methods The clinical data of 205 patients with PCN diagnosed by pathology from July 14, 2003 to July 31, 2018 were analyzed retrospectively. The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.Results The most commonly used preoperative imaging methods were ultrasound and CT, in 146 cases (82.95%) and 141 cases (80.11%), respectively. There were 54 cases (30.68%) with MRI. Of them, 47 cases were examined by single examination, 129 cases received combined examination, of which 123 cases (95.35%) were examined by ultrasound combined with CT. The precise and fuzzy diagnostic rate of PCN by ultrasound, CT, and MRI were 81.51% (119/146), 81.56% (115/141), and 87.04% (47/54), respectively. Comparison of ultrasound with CT and MRI showed statistical significance (χ²=47.747, P<0.001; χ²=11.873, P=0.018), but no significant difference was observed between CT and MRI (χ²=5.012, P>0.05). In 27 cases of false diagnosis by ultrasound, no obvious abnormality was found in 14 cases (51.85%), followed by misdiagnosis as pancreatic pseudocyst (11 cases, 40.74%). Of the 26 cases misdiagnosed as pancreatic cancer by CT, 57.69% (15 cases) were misdiagnosed as pancreatic cancer; 7 cases were misdiagnosed by MRI, 42.86% (3 cases) of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst. Thirty-one cases were misdiagnosed by intraoperative rapid pathology, and most of them misdiagnosed as pancreatic pseudocyst (10 cases, 32.26%). The next was SPN misdiagnosed as pancreatic neuroendocrine tumor (7 cases, 22.58%). The precise and fuzzy diagnostic rates of PCN were 81.58% (124/152), 86.84% (132/152), and 97.37% (148/152) in preoperative imaging, intraoperative rapid pathology, and preoperative imaging combined with intraoperative rapid pathology, while the misdiagnostic rates were 18.42% (28/152), 13.16% (20/152), and 2.63% (4/152), respectively.Conclusions In preoperative imaging and intraoperative rapid pathological examination, it is possible that ultrasound could not find PCN lesions. CT and MRI are most likely to be misdiagnosed as pancreatic cancer. Intraoperative rapid pathological examination misdiagnosed as pancreatic pseudocyst is most common. Perfect preoperative imaging and rapid intraoperative pathology can improve the correct diagnosis rate of PCN and avoid unreasonable surgical intervention measures.

Citation： GONG Xinli, CHENG Kun, LIN Hai, SUN Yonghui, CHEN Qilong. Clinical study of imaging and rapid pathology in diagnosis and treatment of pancreatic cystic neoplasm. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1409-1416. doi: 10.7507/1007-9424.201905096 Copy

1.	Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg, 2004, 239(5): 651-659.
2.	Thosani N, Thosani S, Qiao W, et al. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci, 2010, 55(10): 2756-2766.
3.	Spence RA, Dasari B, Love M, et al. Overview of the investigation and management of cystic neoplasms of the pancreas. Dig Surg, 2011, 28(5-6): 386-397.
4.	彭承宏, 郝純毅, 戴夢華, 等. 胰腺囊性疾病診治指南(2015 版). 臨床肝膽病雜志, 2015, 31(9): 1375-1378.
5.	Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis, 2013, 45(9): 703-711.
6.	Kang CM, Choi SH, Kim SC, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg, 2014, 260(2): 348-355.
7.	徐明月. 基于單中心 15 年治療經驗的胰腺囊性腫瘤惡性風險預測模型的建立與相關基礎研究. 北京: 中國人民解放軍醫學院, 2016.
8.	胡俊, 黃強, 林先盛, 等. 胰腺囊性腫瘤 40 例診療分析. 中國普外基礎與臨床雜志, 2014, 21(10): 1250-1253.
9.	陳宏澤, 孫備, 陳華, 等. 胰腺囊性疾病破裂的診斷與治療(附 20 例臨床病例分析). 中國普外基礎與臨床雜志, 2016, 23(8): 931-935.
10.	展翰翔, 程玉剛, 韓海峰, 等. 胰腺實性假乳頭狀瘤的臨床特征及治療. 中華消化外科雜志, 2017, 16(10): 1005-1012.
11.	Salvia R, Crippa S, Partelli S, et al. Pancreatic cystic tumours: when to resect, when to observe. Eur Rev Med Pharmacol Sci, 2010, 14(4): 395-406.
12.	楊剛, 孔瑞, 武林楓. 胰腺囊性腫瘤的治療進展. 中華胰腺病雜志, 2015, 15(4): 284-288.
13.	程雪彬, 龔建平, 董家剛. 胰腺囊性腫瘤的診斷治療經驗. 中華內分泌外科雜志, 2009, 3(2): 97-99.
14.	Kim HJ, Kim JS, Lee JM, et al. What is the reasonable option for elderly patients with incidental pancreatic cystic neoplasms? Follow-up observation versus surgical resection. Geriatr Gerontol Int, 2017, 17(2): 256-261.
15.	Ketwaroo GA, Mortele KJ, Sawhney MS. Pancreatic cystic neoplasms: an update. Gastroenterol Clin North Am, 2016, 45(1): 67-81.
16.	Hwang DW, Jang JY, Lee SE, et al. Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution. Langenbecks Arch Surg, 2012, 397(1): 93-102.
17.	中華外科青年醫師學術研究社胰腺外科研究組. 中國胰腺囊性腫瘤外科診治現狀分析: 2 251 例報告. 中華外科雜志, 2018, 56(1): 24-29.
18.	Guan F, Hu JX, Wang FQ, et al. An excerpt of European evidence-based guidelines on pancreatic cystic neoplasms (2018). J Clin Hepatol, 2018, 34(6): 1193-1197.
19.	ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc, 2016, 84(1): 1-9.
20.	Schwartz DA, Wiersema MJ. Endoscopic ultrasound techniques for pancreatic cystic neoplasms. Gastrointest Endosc Clin N Am, 2002, 12(4): 709-718.
21.	van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc, 2005, 62(3): 383-389.
22.	Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas, 2011, 40(1): 67-71.
23.	中華外科青年醫師學術研究社胰腺外科研究組. 胰腺囊性腫瘤規范化影像和病理報告的建議. 中華外科雜志, 2018, 56(1): 30-34.

1. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg, 2004, 239(5): 651-659.
2. Thosani N, Thosani S, Qiao W, et al. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci, 2010, 55(10): 2756-2766.
3. Spence RA, Dasari B, Love M, et al. Overview of the investigation and management of cystic neoplasms of the pancreas. Dig Surg, 2011, 28(5-6): 386-397.
4. 彭承宏, 郝純毅, 戴夢華, 等. 胰腺囊性疾病診治指南(2015 版). 臨床肝膽病雜志, 2015, 31(9): 1375-1378.
5. Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis, 2013, 45(9): 703-711.
6. Kang CM, Choi SH, Kim SC, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg, 2014, 260(2): 348-355.
7. 徐明月. 基于單中心 15 年治療經驗的胰腺囊性腫瘤惡性風險預測模型的建立與相關基礎研究. 北京: 中國人民解放軍醫學院, 2016.
8. 胡俊, 黃強, 林先盛, 等. 胰腺囊性腫瘤 40 例診療分析. 中國普外基礎與臨床雜志, 2014, 21(10): 1250-1253.
9. 陳宏澤, 孫備, 陳華, 等. 胰腺囊性疾病破裂的診斷與治療(附 20 例臨床病例分析). 中國普外基礎與臨床雜志, 2016, 23(8): 931-935.
10. 展翰翔, 程玉剛, 韓海峰, 等. 胰腺實性假乳頭狀瘤的臨床特征及治療. 中華消化外科雜志, 2017, 16(10): 1005-1012.
11. Salvia R, Crippa S, Partelli S, et al. Pancreatic cystic tumours: when to resect, when to observe. Eur Rev Med Pharmacol Sci, 2010, 14(4): 395-406.
12. 楊剛, 孔瑞, 武林楓. 胰腺囊性腫瘤的治療進展. 中華胰腺病雜志, 2015, 15(4): 284-288.
13. 程雪彬, 龔建平, 董家剛. 胰腺囊性腫瘤的診斷治療經驗. 中華內分泌外科雜志, 2009, 3(2): 97-99.
14. Kim HJ, Kim JS, Lee JM, et al. What is the reasonable option for elderly patients with incidental pancreatic cystic neoplasms? Follow-up observation versus surgical resection. Geriatr Gerontol Int, 2017, 17(2): 256-261.
15. Ketwaroo GA, Mortele KJ, Sawhney MS. Pancreatic cystic neoplasms: an update. Gastroenterol Clin North Am, 2016, 45(1): 67-81.
16. Hwang DW, Jang JY, Lee SE, et al. Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution. Langenbecks Arch Surg, 2012, 397(1): 93-102.
17. 中華外科青年醫師學術研究社胰腺外科研究組. 中國胰腺囊性腫瘤外科診治現狀分析: 2 251 例報告. 中華外科雜志, 2018, 56(1): 24-29.
18. Guan F, Hu JX, Wang FQ, et al. An excerpt of European evidence-based guidelines on pancreatic cystic neoplasms (2018). J Clin Hepatol, 2018, 34(6): 1193-1197.
19. ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc, 2016, 84(1): 1-9.
20. Schwartz DA, Wiersema MJ. Endoscopic ultrasound techniques for pancreatic cystic neoplasms. Gastrointest Endosc Clin N Am, 2002, 12(4): 709-718.
21. van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc, 2005, 62(3): 383-389.
22. Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas, 2011, 40(1): 67-71.
23. 中華外科青年醫師學術研究社胰腺外科研究組. 胰腺囊性腫瘤規范化影像和病理報告的建議. 中華外科雜志, 2018, 56(1): 30-34.

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Clinical study of imaging and rapid pathology in diagnosis and treatment of pancreatic cystic neoplasm

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