Wu Wenchuan, Li Ji, Pu Ning, Li Gang, Wang Xin, Zhao Gang, Wang Lei, Tian Xiaodong, Yuan Chunhui, Miao Yi, Jiang Kuirong, Cao Jun, Xu Xiaowu, Bai Xueli, Yang Yongsheng, Liu Fubao, Bai Xuewei, Kong Rui, Wang Zheng, Fu Deliang, Lou Wenhui
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Ann Transl Med. 2019 Dec;7(24):807. doi: 10.21037/atm.2019.12.70.
Serous cystic neoplasms (SCN) rarely have malignant potential, so accurate diagnosis of SCN is crucial for proper clinical management, especially to avoid unnecessary surgeries. However, the misdiagnosis of other pancreatic cystic neoplasm instead of SCN may highly increase the risk of malignancy in patients who receive no surgery.
Data from a total of 678 patients with pathologically confirmed to have SCN at sixteen institutions in China from January 1, 2006 to December 31, 2016 were retrieved to evaluate the malignancy risk of SCN.
Among the 678 patients confirmed to have SCN with postoperative pathologic analysis, 649 patients (95.7%) had only one lesion and the average maximum diameter was 3.8±2.47 cm. Four patients were pathologically verified as having serous cystadenocarcinoma, so the SCN actual malignancy rate was 0.6%, while the mortality due to pancreatic surgery in these high-volume centers was nearly 0.2-2%. However, among the 99 SCN patients based on preoperative radiology, three were confirmed to have intraductal papillary mucinous neoplasms (IPMN), nine as mucinous cystic neoplasms (MCN), and four as solid pseudopapillary tumors (SPT) after postoperative pathological analysis. Thus, the total theoretical malignancy rate resulting from preoperative misdiagnosis was elevated to approximately 2.9%, higher than the risk of perioperative mortality.
When SCN can't be accurately distinguished from cystic tumors of pancreas, the malignant risk of cystic tumors may be higher than perioperative risk. However, if it can be diagnosed as SCN accurately, surgery can be avoided as well.
浆液性囊性肿瘤（SCN）很少具有恶性潜能，因此准确诊断SCN对于正确的临床管理至关重要，特别是为了避免不必要的手术。然而，将其他胰腺囊性肿瘤误诊为非SCN可能会显著增加未接受手术患者的恶性风险。
检索了2006年1月1日至2016年12月31日期间中国16家机构中678例经病理证实患有SCN的患者的数据，以评估SCN的恶性风险。
在678例经术后病理分析确诊为SCN的患者中，649例（95.7%）仅有一个病灶，平均最大直径为3.8±2.47cm。4例经病理证实为浆液性囊腺癌，因此SCN的实际恶性率为0.6%，而在这些高容量中心，胰腺手术导致的死亡率接近0.2%-2%。然而，在术前影像学诊断为SCN的99例患者中，术后病理分析显示，3例被确诊为导管内乳头状黏液性肿瘤（IPMN），9例为黏液性囊性肿瘤（MCN），4例为实性假乳头状肿瘤（SPT）。因此，术前误诊导致的总理论恶性率升至约2.9%，高于围手术期死亡率风险。
当SCN无法与胰腺囊性肿瘤准确区分时，囊性肿瘤的恶性风险可能高于围手术期风险。然而，如果能准确诊断为SCN，也可避免手术。
