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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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, 郝纯毅, 戴梦华, 等. 胰腺囊性疾病诊治指南(2015 版). 临床肝胆病杂志, 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. 基于单中心 15 年治疗经验的胰腺囊性肿瘤恶性风险预测模型的建立与相关基础研究. 北京: 中国人民解放军医学院, 2016.
8.	胡俊, 黄强, 林先盛, 等. 胰腺囊性肿瘤 40 例诊疗分析. 中国普外基础与临床杂志, 2014, 21(10): 1250-1253.
9.	陈宏泽, 孙备, 陈华, 等. 胰腺囊性疾病破裂的诊断与治疗(附 20 例临床病例分析). 中国普外基础与临床杂志, 2016, 23(8): 931-935.
10.	展翰翔, 程玉刚, 韩海峰, 等. 胰腺实性假乳头状瘤的临床特征及治疗. 中华消化外科杂志, 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.	杨刚, 孔瑞, 武林枫. 胰腺囊性肿瘤的治疗进展. 中华胰腺病杂志, 2015, 15(4): 284-288.
13.	程雪彬, 龚建平, 董家刚. 胰腺囊性肿瘤的诊断治疗经验. 中华内分泌外科杂志, 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.	中华外科青年医师学术研究社胰腺外科研究组. 中国胰腺囊性肿瘤外科诊治现状分析: 2 251 例报告. 中华外科杂志, 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.	中华外科青年医师学术研究社胰腺外科研究组. 胰腺囊性肿瘤规范化影像和病理报告的建议. 中华外科杂志, 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, 郝纯毅, 戴梦华, 等. 胰腺囊性疾病诊治指南(2015 版). 临床肝胆病杂志, 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. 基于单中心 15 年治疗经验的胰腺囊性肿瘤恶性风险预测模型的建立与相关基础研究. 北京: 中国人民解放军医学院, 2016.
8. 胡俊, 黄强, 林先盛, 等. 胰腺囊性肿瘤 40 例诊疗分析. 中国普外基础与临床杂志, 2014, 21(10): 1250-1253.
9. 陈宏泽, 孙备, 陈华, 等. 胰腺囊性疾病破裂的诊断与治疗(附 20 例临床病例分析). 中国普外基础与临床杂志, 2016, 23(8): 931-935.
10. 展翰翔, 程玉刚, 韩海峰, 等. 胰腺实性假乳头状瘤的临床特征及治疗. 中华消化外科杂志, 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. 杨刚, 孔瑞, 武林枫. 胰腺囊性肿瘤的治疗进展. 中华胰腺病杂志, 2015, 15(4): 284-288.
13. 程雪彬, 龚建平, 董家刚. 胰腺囊性肿瘤的诊断治疗经验. 中华内分泌外科杂志, 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. 中华外科青年医师学术研究社胰腺外科研究组. 中国胰腺囊性肿瘤外科诊治现状分析: 2 251 例报告. 中华外科杂志, 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. 中华外科青年医师学术研究社胰腺外科研究组. 胰腺囊性肿瘤规范化影像和病理报告的建议. 中华外科杂志, 2018, 56(1): 30-34.

Previous Article
乳腺癌的免疫治疗进展
Next Article
Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content