Non-inflammatory pancreatic cysts: from diagnosis to treatment (97 cases series)

ABSTRACT Objective: to describe the implications of the diagnosis and treatment of non-inflammatory pancreatic cysts in a series of patients. Methods: we included patients with pancreatic cysts ≥1.0 cm, excluding those with a presumptive diagnosis of a pseudocyst. Imaging tests, echoendoscopy, and histopathology determined the diagnosis of the type of cyst. We applied the guidelines of the International Association of Pancreatology, with some modifications, in patients with mucinous or indeterminate lesions. Results: 97 adult patients participated in the study. A cystic neoplasm of the pancreas was diagnosed in 82.5% of cases. Diagnosis was mainly made by magnetic resonance (46% of cases). The two most common diagnoses were intraductal papillary mucinous neoplasm (43.3%) and serous cystadenoma (26%). Twenty-nine patients underwent surgery (33.3%). The most common surgical procedure was distal pancreatectomy associated with splenectomy in 19 cases (65.5%). Among the operated patients, 11 were diagnosed with cancer. None of the followed, non-operated patients had a diagnosis of cancer. Conclusions: magnetic resonance showed good accuracy, particularly in the diagnosis of intraductal papillary mucinous neoplasm. The guidelines of the International Association of Pancreatology, as applied in this study, showed a negative predictive value for cancer of 100%. A development of better diagnostic tests can reduce the number of unnecessary operations.

摘要
目的：探讨非炎性胰腺囊肿的诊疗策略对一组患者的临床意义。
方法：本研究纳入直径≥1.0 cm的胰腺囊肿患者，排除疑似假性囊肿的病例。通过影像学检查、内镜超声及组织病理学明确囊肿的具体类型诊断。针对黏液性或性质未定的病变患者，本研究采用国际胰腺病协会（International Association of Pancreatology）指南并稍作调整。
结果：本研究共纳入97例成年患者。其中82.5%的病例被确诊为胰腺囊性肿瘤。诊断主要依靠磁共振成像（magnetic resonance），占比达46%。最常见的两种诊断类型为导管内乳头状黏液性肿瘤（Intraductal Papillary Mucinous Neoplasm）与浆液性囊腺瘤（Serous Cystadenoma），占比分别为43.3%与26%。29例患者接受手术治疗，占总病例数的33.3%。最常用的手术方式为远端胰腺切除术联合脾切除术，共19例，占手术患者总数的65.5%。在接受手术的患者中，11例被确诊为恶性肿瘤。所有接受随访的未手术患者均未确诊为恶性肿瘤。
结论：磁共振成像展现出良好的诊断准确性，尤其在导管内乳头状黏液性肿瘤的诊断中。本研究应用的国际胰腺病协会指南对恶性肿瘤的阴性预测值达100%。开发更优质的诊断检测手段可减少不必要的手术操作。