Birnbaum David Jérémie, Gaujoux Sébastien, Berbis Julie, Dokmak Safi, Hammel Pascal, Vullierme Marie Pierre, Lévy Philippe, Sauvanet Alain
AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France.
AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Clichy, France.
Surgery. 2017 Jul;162(1):112-119. doi: 10.1016/j.surg.2017.01.015. Epub 2017 Feb 23.
Accurate preoperative diagnosis is critical for the determination of appropriate surgical indications. The aim of this study was to assess the accuracy of preoperative diagnosis and indications for operative therapy for presumed pancreatic neoplasms.
From 2005 to 2013, 851 patients underwent pancreatectomies for presumed pancreatic neoplasms. A formal preoperative diagnosis was established during a multidisciplinary tumor board and compared to the final pathologic examination. The preoperative diagnosis and its accuracy were assessed according to demographics, symptoms, and diagnostic workup.
Tumors were benign in 8% of patients (n = 67), premalignant in 43% (n = 370), and malignant in 49% (n = 414). The mean number of preoperative examinations was 3.2; 27% (n = 144) of patients had computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination all performed together. Preoperative diagnosis was confirmed in 89% of patients (n = 754). The morbidity and mortality rates were 65% and 1%, respectively. Of the 97 patients (11%) with a misdiagnosis, operative resection was ultimately relevant (premalignant, malignant tumor, or symptomatic benign tumor) in 51 (6%) but inappropriate in 46 (5%). The rate of misdiagnosis was increased for cystic lesions and in patients under 50 years of age. For lesions <2 cm, diagnostic accuracy was increased when computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination were all performed together.
Misdiagnosis can lead to an inappropriate resection in 5% of patients with presumed pancreatic neoplasms. For lesions difficult to characterize, such as small and cystic lesions, association of several modalities of preoperative workup could help to decrease the rate of inappropriate operative care.
准确的术前诊断对于确定合适的手术指征至关重要。本研究的目的是评估术前诊断的准确性以及对疑似胰腺肿瘤进行手术治疗的指征。
2005年至2013年期间，851例患者因疑似胰腺肿瘤接受了胰腺切除术。在多学科肿瘤委员会会议期间确立了正式的术前诊断，并与最终病理检查结果进行比较。根据人口统计学、症状和诊断检查评估术前诊断及其准确性。
8%的患者（n = 67）肿瘤为良性，43%（n = 370）为癌前病变，49%（n = 414）为恶性。术前检查的平均次数为3.2次；27%（n = 144）的患者同时进行了计算机断层扫描、磁共振成像、内镜超声检查和细针检查。89%的患者（n = 754）术前诊断得到证实。发病率和死亡率分别为65%和1%。在97例（11%）误诊患者中，手术切除最终是必要的（癌前病变、恶性肿瘤或有症状的良性肿瘤）有51例（6%），但不适当的有46例（5%）。囊性病变和50岁以下患者的误诊率有所增加。对于直径<2 cm的病变，当同时进行计算机断层扫描、磁共振成像、内镜超声检查和细针检查时，诊断准确性会提高。
误诊可能导致5%的疑似胰腺肿瘤患者接受不适当的切除手术。对于难以定性的病变，如小的和囊性病变，多种术前检查方法联合使用有助于降低不适当手术治疗的发生率。
