Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients

Abstract

ObjectivesThe preoperative diagnosis between serous cystadenomas (SCAs) and mucinous cystadenomas (MCAs) in pancreas is significant due to their completely different biological behaviors. The purpose of our study was to examine and compare detailed contrast-enhanced ultrasonography (CEUS) images of SCAs and MCAs and to determine whether there are significant findings that can contribute to the discrimination between these two diseases.MethodsFrom April 2015 to June 2016, 61 patients (35 patients with SCAs and 26 patients with MCAs) were enrolled in this study. Forty-three cases were confirmed by surgical pathology and 18 by comprehensive clinical diagnoses. All of the CEUS characteristics of these lesions were recorded: size, location, echogenicity, shape, wall characteristics, septa characteristics, and the presence of a honeycomb pattern or nodules. CEUS examinations were performed by two ultrasound physicians.ResultsLocation (P=0.003), shape (P=0.000), thickness of the wall (P=0.005), the number of septa (P=0.001), and the honeycomb pattern (P=0.001) were statistically significantly different. A head–neck location, a lobulated shape, an inner regular honeycomb pattern, and a thin wall (<3 mm thick) were significant in diagnosing patients with SCAs. When two of these four findings were combined, we could achieve a sensitivity of 71.4% and a specificity of 80.8% to diagnose SCA; when three of these four findings were combined, the specificity was 100%. A body–tail location, a round/oval shape, 0–2 septa, and a thick wall (≥3 mm thick) were most often detected in patients with MCAs. When two of these four findings were combined, we could achieve a sensitivity of 88.5% and a specificity of 65.7% to diagnose MCA; when three of these four findings were combined, the area under the curve (Az) was highest at 0.832, with a sensitivity of 80.8% and a specificity of 85.7%.ConclusionsThe characteristics of tumor location, shape, thickness of the wall, the number of septa, and the honeycomb pattern by CEUS play an important role in the diagnosis of SCAs and MCAs. A combination of these findings can provide better diagnostic performance in the discrimination of SCAs from MCAs.

A prospective study on endoscopic ultrasound for the differential diagnosis of serous cystic neoplasms and mucinous cystic neoplasms

“…The BD-IPMNs are composed of cysts that communicate with the main pancreatic duct [12]. Both IPMN and pseudocysts are predominant in men and are prone to pancreatitis [13, 14]. Our study revealed that SCNs and MCNs occurred more frequently in women, which was consistent with previous studies.…”

“…When any two imaging features were combined, we obtained the highest Az value (0.824) in diagnosing SCNs, as well as the appropriate sensitivity (84.2%), specificity (80.6%), PPV (84.2%), NPV(80.6%) which was almost consistent with study by Sun Y [14]. The four specific imaging features used in the study by Sun Y [14] for the diagnosis of SCNs were head/neck location, lobulated shape, thin wall (0–2 mm) and honeycomb pattern, which were slightly different from the imaging features used in our study. We believed that the honeycomb pattern was more specific for the diagnosis of SCNs than the number of septa > 2 but excluded a large portion of atypical SCNs.…”

“…Compared with any other single imaging signs in the diagnosis of MCNs, round shape had the highest Az value (0.756), with a relatively appropriate sensitivity (77.4%), specificity (73.7%), PPV (70.6%) and NPV (80.0%). When the imaging features were combined, the combined diagnosis of any three features could obtain the highest Az value (0.808), as well as the appropriate sensitivity (77.4%), specificity (84.2%), PPV (80.0%) and NPV (82.1%), which was almost consistent with the results reported by Sun Y [14]. The combined diagnosis of any three features was more advantageous than the round shape feature in the diagnosis of MCNs.…”

Characterization of Cystic Lesions of Pancreas by Computed Tomography Scan- A Retrospective Study

“…[19] Sun et al showed honeycomb pattern is seen in serous cystadenoma and side branch IPMT whereas none of the mucinous cystadenoma showed honeycomb pattern. [21] Honeycomb appearance is seen in serous cystadenomas and side branch IPMT but rarely has been reported in mucinous cystadenoma. [22] Mucinous cystadenomas have thick (>3 mm) wall and serous cystadenomas have thin wall (<3 mm).…”

<p>Comparative Diagnostic Evaluation with Contrast-Enhanced Ultrasound, Computed Tomography and Magnetic Resonance Imaging in Patients with Pancreatic Cystic Neoplasms</p>

“…19 There are several published reports of using CEUS in PCLs, which proved that CEUS can play a vital role in improving the diagnostic rate of pancreatic cystic lesions. 12,13,[20][21][22] However, no study has compared the diagnostic performance of CEUS with CT and MRI in pancreatic neoplasms. In this study, we prospectively compared the diagnostic capability of CT, MRI, and CEUS of 90 patients with PCNs who were finally confirmed surgicopathologically and analyzed the mainly detailed characterization of these lesions.…”