Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Department of Radiology, Baylor College of Medicine, Houston, Texas.
J Surg Res. 2019 Apr;236:144-152. doi: 10.1016/j.jss.2018.11.032. Epub 2018 Dec 17.
Identification of incidental pancreatic lesions is increasing because of advancements in imaging. Diagnosis remains a challenge for clinicians, with intrapancreatic accessory spleens (IPAS) posing a unique dilemma. IPAS are frequently resected because of inability to exclude alternate diagnoses, subjecting patients to unnecessary risk. The purpose of this study was to examine our institutional experience with IPAS and develop a multidisciplinary algorithm to improve preoperative diagnosis.
Patients who underwent a distal pancreatectomy at a single institution from 2005 to 2018 were identified from a prospectively maintained database. Examination of final pathology for a diagnosis of IPAS yielded the final cohort. Demographics, preoperative workup, and operative course were reviewed and analyzed. A diagnostic algorithm was composed based on the consensus of a panel of expert pancreatic surgeons, a radiologist, and a pathologist.
Ten patients of 303 patients who underwent a distal pancreatectomy were identified with a final pathology of IPAS. The average age was 54 y, 80% were white, and 60% were male. Lesions ranged in size from 7 mm to 5.1 cm in largest diameter (mean 2.2 cm). Lesions were described as round, well-marginated, and enhancing masses within the pancreatic tail. Preoperative workup was variable in terms of imaging and laboratory testing. Diagnostic workups were examined and combined with multidisciplinary input to create a diagnostic algorithm.
Incidental pancreatic lesions like IPAS remain a diagnostic challenge for clinicians. Employing a diagnostic algorithm as proposed may aid in the distinction of malignant and premalignant pathology and prevent unwarranted pancreatic resections.
由于影像学的进步，偶然发现的胰腺病变的数量正在增加。由于胰腺内副脾（intrapancreatic accessory spleens，IPAS）的存在给临床医生带来了独特的诊断困境，因此诊断仍然是一个挑战。由于无法排除其他诊断，IPAS 经常被切除，使患者面临不必要的风险。本研究旨在探讨我们机构在 IPAS 方面的经验，并制定多学科算法以改善术前诊断。
从一家机构的前瞻性维护数据库中确定了 2005 年至 2018 年期间接受胰体尾切除术的患者。对最终病理学检查为 IPAS 的患者进行了分析，得到了最终队列。回顾并分析了患者的人口统计学、术前检查和手术过程。根据一组胰腺外科专家、放射科医生和病理学家的共识制定了诊断算法。
在 303 例接受胰体尾切除术的患者中，有 10 例患者的最终病理为 IPAS。患者的平均年龄为 54 岁，80%为白人，60%为男性。病变大小从 7mm 到 5.1cm 不等（平均直径为 2.2cm）。病变描述为圆形、边界清楚、增强的胰腺尾部肿块。术前检查在影像学和实验室检查方面存在差异。对诊断性检查进行了检查，并结合多学科的意见制定了诊断算法。
像 IPAS 这样的偶然胰腺病变仍然是临床医生面临的诊断挑战。采用所提出的诊断算法可能有助于区分恶性和癌前病变，并防止不必要的胰腺切除术。
