Cystic neoplasms of the pancreas: evaluation with endoscopic retrograde pancreatography.

Images from endoscopic retrograde pancreatography performed in 38 patients with cystic pancreatic neoplasms were reviewed to determine whether they might allow differentiation of malignant from benign lesions. Twenty-three patients had histologically proved benign lesions; 15 had frankly malignant lesions. Images were classified into four groups on the basis of the appearance of the pancreatic duct: (a) normal, (b) showing narrowing or draping; (c) showing communication with a cystic space, and (d) showing obstruction. Of the 23 patients with benign lesions, eight had normal studies, 11 had studies showing narrowing or draping, three had studies showing communication, and one had a study showing obstruction. Of the 15 patients with malignant lesions, one had a normal study, three had studies showing narrowing or draping, two had studies showing communication, and nine had studies showing obstruction. Overall, there was a significant difference in the rates of pancreatographic findings for benign and malignant tumors (P = .001). Although no finding proved to be an absolute indicator of benign or malignant disease, obstruction occurred with 60% of malignant tumors and was seen with only one benign lesion (4%).