Cystic Neoplasms of the Pancreas

Objectives: To identify clinical, radiographic, and histopathologic characteristics associated with cancer in cystic pancreatic neoplasms and to evaluate our preoperative diagnostic accuracy to predict cancer in such cysts. Methods: Retrospective case series of 114 patients with cystic lesions of the pancreas who underwent resection between 1992 and 2006. Results: Eighty-nine patients (78%) had benign or premalignant cysts; 25 patients (22%) had malignant cysts (carcinoma in situ and/or an invasive cancer). The factors most predictive of malignancy were age (P = 0.03), presence of symptoms (P = 0.02), and a dilated pancreatic duct (P = 0.01). Of the symptoms recorded, weight loss (P = 0.01) and jaundice (P = 0.02) had the strongest correlation with malignancy. We correctly predicted the pathological diagnosis (benign vs malignant) for only 39 (67%) of the 58 patients where a preoperative diagnosis was clearly evident. Endoscopic ultrasound did not seem to improve our ability to preoperatively differentiate benign from malignant cysts (P 9 0.05). Conclusions: This series confirms that age, the presence of symptoms, and a dilated pancreatic duct on imaging are significantly associated with cancer in pancreatic cysts, and it highlights our inability to consistently make the preoperative diagnosis of cancer. Until more accurate markers of malignancy are available, an aggressive approach to management seems justified.