Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

Abstract

ObjectiveTo determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst.Materials and MethodsThis study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher's exact test was used to analyze the results.ResultsA combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different.ConclusionThe CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.

Calcified peripancreatic lymph nodes in pancreatic and hepatic tuberculosis mimicking pancreatic malignancy

“…[ 3 ] The morphologies are inconsistent, including irregular, striped, speckled, focal, sand-like calcifications, calcifications forming polycyclic structures, and so on. [ 2 , 5 , 6 , 11 , 13 , 15 , 17 , 18 , 34 , 35 ] Calcifications in pancreatic malignancies have been well described previously, [ 21 , 22 , 28 , 30 ] although there is a lack of summaries of calcifications in pancreatic tuberculosis, partly because of its rarity. Based on these reports, calcifications may be useful, but not specific imaging criteria for the differentiation of pancreatic tuberculosis from malignancy.…”

“…Based on these reports, calcifications may be useful, but not specific imaging criteria for the differentiation of pancreatic tuberculosis from malignancy. [ 3 , 6 , 7 , 15 , 17 , 21 , 22 , 28 , 30 ]…”

Mucinous cystadenoma of pancreas with honeycombing appearance: Radiological-Pathological correlation

“…Mucinous cystadenomas are usually macrocystic (>5 cm) with a smooth contour with or without septations. [ 12 ] Calcifications if present tend to be more peripheral in nature. [ 13 14 ] They can exert mass effect over the pancreatic duct and cause duct obstruction.…”

Characterization of Pancreatic Serous Cystadenoma on Dual-Phase Multidetector Computed Tomography

“…4,6–9 Accuracy of preoperative CT diagnosis has been reported to be as low as 23.3%. 3 It has been suggested that the predictive value of CT for diagnosis of pancreatic serous cystadenomas may improve with increased number of detectors, from 3.6% in CTs with less than 64 detectors to 28.7% in CTs with 64 detectors or more.…”