Central Surgical AssociationManagement of suspected pancreatic cystic neoplasms based on cyst size
Section snippets
Patients and methods
An institutional review board–approved, prospective evaluation and management protocol was initiated in September 1999 for adults with suspected pancreatic cystic neoplasm observed in the Digestive Disease Institute at the Cleveland Clinic. Patients are managed independent of cyst size, and patients are advised to undergo resection based on defined criteria: the presence of symptoms, abnormal cyst aspiration fluid, and radiologic criteria. Symptoms included abdominal pain, jaundice,
Results
A total of 500 patients have been managed from September 1999 through December 2006, with the Figure outlining the overall results of management. The entire group included 326 women and 174 men with a mean age of 64 (22 to 93) years. A total of 125 patients (25%) were operated principally for symptoms and/or aspiration results. Compared with patients not operated, patients that underwent operation were significantly more likely to be symptomatic (64 vs 35%; P < .001) and younger (58 vs 66 mean
Discussion
A need exists for increased outcomes data for patients with suspected pancreatic cystic neoplasms. The need is pressing, but there are conflicting concerns: the number of patients at risk is large because of expanded use of cross-sectional imaging, pancreatic surgery is an increasingly safe procedure at major centers, plus high patient and physician anxiety about a delay in diagnosis of pancreatic carcinoma. Little true guidance can be found in most of the surgical literature because most
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Cited by (82)
Advances in the management of pancreatic cystic neoplasms
2021, Current Problems in SurgeryEarly Detection of Pancreatic Cancer: Opportunities and Challenges
2019, GastroenterologyCitation Excerpt :Furthermore, a thickened cyst wall is present in 65% of cases with malignancy.31,113 Studies have shown a direct relationship between BD-IPMN size and the risk of malignancy; however, BD-IPMN–associated cancers can occur in small cysts, and larger cysts do not always harbor pancreatic cancer.34,48,114–116 In the absence of a more practical approach, the Fukuoka and ACG guidelines advocate for varying time intervals for surveillance based on BD-IPMN size.
Incidental Intraductal Papillary Mucinous Neoplasm, Cystic or Premalignant Lesions of the Pancreas: The Case for Aggressive Management
2018, Surgical Clinics of North AmericaCitation Excerpt :According to the Sendai guidelines,24,68 BD-IPMNs have been treated according to risk stratification. However, several large series have implied that even small and asymptomatic side-branch IPMNs without suspicious radiologic features contain a risk of invasive carcinoma that may be as high as 20%.51,65,66,69 Also, cyst size may be inaccurate for predicting malignant risk.69
AKR1B10 expression by immunohistochemistry in surgical resections and fine needle aspiration cytology material in patients with cystic pancreatic lesions; potential for improved nonoperative diagnosis
2017, Human PathologyCitation Excerpt :Despite advances in the quality of imaging, the addition of fine needle aspiration (FNA) cytology and cyst fluid evaluation, malignancy cannot be excluded without surgical resection, and this often involves procedures with significant risk of morbidity. Because IPMNs and MCNs display a diverse spectrum of biological and clinical behaviors, accurate diagnosis and preoperative assessment of these lesions are critical in determining the optimal management for these patients [7-11]. Aldo-keto reductase family 1 B10 (AKR1B10) protein detoxifies reactive free radical carbonyl compounds and is involved in retinoid metabolism, thus modulating cell proliferation, differentiation, and tumorigenesis [12].
Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee
2017, Journal of the American College of Radiology
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