Goh Brian K P, Tan Yu-Meng, Thng Choon-Hua, Cheow Peng-Chung, Chung Yaw-Fui Alexander, Chow Pierce K H, Wong Wai-Keong, Ooi London L P J
Department of Surgery, Singapore General Hospital, Singapore.
J Am Coll Surg. 2008 Jan;206(1):17-27. doi: 10.1016/j.jamcollsurg.2007.06.312. Epub 2007 Oct 1.
This study aims to determine the use of preoperative clinical, biochemical, and cross-sectional imaging features for predicting malignancy in cystic lesions of the pancreas (CLP).
Two hundred twenty patients who underwent operations for CLP or suspected CLP were reviewed. Patients were divided into two groups, patients undergoing operations for pseudocysts and patients undergoing operations for suspected cystic neoplasms. The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated.
Forty-four patients with a preoperative diagnosis of pseudocysts underwent operations for complications of pseudocyst. Forty-two were confirmed pathologically to have pseudocysts, but two were found, unexpectedly, to harbor malignant lesions. One hundred seventy-six patients underwent operations for suspected pancreatic cystic neoplasms. There were 70 benign, 51 potentially malignant, and 55 malignant CLP. On multivariate analysis, three factors, ie, elevated serum carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9; cyst size > 3 cm; and presence of one or more of three morphologic features, such as solid component; peripheral calcification; and main duct dilation on cross-sectional imaging were independent predictors of malignancy. Presence of two or three of these factors had a positive predictive value of 88% in predicting a premalignant or malignant CLP.
Most pancreatic pseudocysts can be accurately diagnosed preoperatively. In patients with suspected pancreatic cystic neoplasms, elevated serum CEA or carbohydrate antigen 19-9, cyst size > 3 cm, and presence of suspicious morphologic features on imaging are predictors of potentially malignant or malignant CLP. Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.
本研究旨在确定术前临床、生化及横断面成像特征在预测胰腺囊性病变（CLP）恶性程度方面的应用。
回顾了220例行CLP或疑似CLP手术的患者。患者分为两组，一组为行假性囊肿手术的患者，另一组为行疑似囊性肿瘤手术的患者。评估了各种术前因素对CLP恶性潜能的预测作用。
44例术前诊断为假性囊肿的患者因假性囊肿并发症接受手术。42例经病理证实为假性囊肿，但意外发现2例存在恶性病变。176例患者因疑似胰腺囊性肿瘤接受手术。其中70例为良性CLP，51例为潜在恶性CLP，55例为恶性CLP。多因素分析显示，血清癌胚抗原（CEA）或糖类抗原19-9升高、囊肿大小>3 cm以及横断面成像存在实性成分、周边钙化和主胰管扩张这三种形态学特征中的一种或多种这三个因素是恶性的独立预测因素。存在其中两个或三个因素对预测癌前或恶性CLP的阳性预测值为88%。
大多数胰腺假性囊肿术前可准确诊断。对于疑似胰腺囊性肿瘤的患者，血清CEA或糖类抗原19-9升高、囊肿大小>3 cm以及成像存在可疑形态学特征是潜在恶性或恶性CLP的预测因素。基于这三个因素高度怀疑存在潜在恶性或恶性病变的患者应直接接受手术，无需进一步检查。
