The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
HPB (Oxford). 2008;10(6):483-90. doi: 10.1080/13651820802291225.
Cystic lesions of the pancreas are being identified more frequently. Deciding which asymptomatic lesions can be safely followed with serial imaging and which require resection due to malignant potential is an increasingly common question. Current clinical practice is to rely on characteristics of the lesions on CT scan, and additional information from endoscopic ultrasound with fine-needle aspiration (EUS-FNA) and cyst fluid analysis or endoscopic retrograde pancreatography (ERCP) to assess malignant potential.
The malignant potential of pancreatic cystic lesions cannot be accurately predicted by CT scan.
CT scans from 48 patients with cystic lesions of the pancreas were stripped of patient identifiers and retrospectively presented to two expert radiologists. The radiologists recorded specific characteristics of the lesions thought to be important in the differential diagnosis and their opinion of the likely diagnosis. Diagnostic accuracy was assessed by comparing the radiologists' diagnoses to the final pathologic diagnosis after resection. To determine if clinical history, EUS-FNA or ERCP findings improved diagnostic accuracy, medical records were retrospectively reviewed and scored as either supporting or not supporting malignant potential of the lesion.
Specific diagnoses based on CT findings alone were correct in an average of 39% of the cases. Even when diagnoses were dichotomized as benign (43%) or potentially malignant (57%, papillary mucinous neoplasms, mucinous cystic neoplasms, cancer), determinations based on CT alone were accurate in an average of 61% of cases. Accuracy rates were 60.4 and 62.5% for the two radiologists, although there was only fair agreement between them (Kappa=0.28, 95% CI=(0.01-0.55), p=0.05). When all clinical information available was considered together as a single dichotomous indicator of malignant potential, the indicator was accurate in 90% of the cases (Kappa=0.73, 95% CI=(0.51-0.95, p<0.0001)).
Specific preoperative diagnosis of pancreatic cystic neoplasms by CT alone is substantially inaccurate. Complementary tests such as EUS-FNA with fluid analysis and ERCP should be recommended to improve diagnosis especially if nonoperative treatment is planned.
胰腺囊性病变的检出率越来越高。目前，如何确定哪些无症状的病变可以通过连续影像学检查安全随访，而哪些需要因恶性潜能而切除，是一个日益常见的问题。目前的临床实践依赖于 CT 扫描中病变的特征，以及来自内镜超声引导下细针抽吸（EUS-FNA）和囊液分析或内镜逆行胰胆管造影（ERCP）的附加信息，以评估恶性潜能。
CT 扫描无法准确预测胰腺囊性病变的恶性潜能。
对 48 例胰腺囊性病变患者的 CT 扫描进行去标识处理，然后由两位专家放射科医生进行回顾性分析。放射科医生记录了他们认为对鉴别诊断重要的病变的具体特征，并对可能的诊断意见进行了记录。通过比较放射科医生的诊断与切除后的最终病理诊断来评估诊断准确性。为了确定临床病史、EUS-FNA 或 ERCP 的结果是否能提高诊断准确性，对病历进行了回顾性分析，并根据是否支持病变的恶性潜能进行评分。
单纯基于 CT 发现的特定诊断在平均 39%的病例中是正确的。即使将诊断分为良性（43%）或可能恶性（57%，包括胰腺导管内乳头状黏液性肿瘤、黏液性囊性肿瘤、癌症），单纯基于 CT 的诊断在平均 61%的病例中也是准确的。两位放射科医生的准确率分别为 60.4%和 62.5%，但他们之间的一致性仅为中等（Kappa=0.28，95%CI=(0.01-0.55)，p=0.05）。当综合考虑所有可用的临床信息作为恶性潜能的单一二分指示物时，该指示物在 90%的病例中是准确的（Kappa=0.73，95%CI=(0.51-0.95，p<0.0001））。
单纯依靠 CT 术前诊断胰腺囊性肿瘤的准确率较低。应推荐进行补充检查，如 EUS-FNA 联合囊液分析和 ERCP，以提高诊断准确率，特别是如果计划非手术治疗。
