Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound

Yarandi, Shadi S.; Runge, Thomas M.; Wang, Lei; Liu, Zhijian; Jiang, Yueping; Chawla, Saurabh; Woods, Kevin E.; Keilin, Steven; Willingham, Field F.; Hong, Xu; Cai, Qiang

doi:10.1155/2014/701535

Cited by 16 publications

(8 citation statements)

References 17 publications

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“…23,24 The 29% of DA patients who were found to harbor malignancy on final pathology were statistically more likely to be over the age of 70, require a preoperative biliary stent, and have a bile duct diameter greater than 8 mm. These findings are similar to those reported by Yarandi et al, 25 where jaundice and ductal dilation were most associated with malignancy. Tumor size and presence of high-grade dysplasia on biopsy were less predictive of malignancy on final pathology, contrary to findings reported by Okada et al, 3 where tumor size > 20 mm and high-grade dysplasia were most predictive.…”

Section: Discussionsupporting

confidence: 92%

Relationship between Cancer Diagnosis and Complications Following Pancreatoduodenectomy for Duodenal Adenoma

et al. 2020

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Background.-Pancreatoduodenectomy (PD) for duodenal adenoma (DA) resection may be associated with excessive surgical risk for patients with potentially benign lesions, given the absence of pancreatic duct obstruction. We examined factors associated with final malignant pathology and evaluated the postoperative course of patients with DA versus pancreatic ductal adenocarcinoma (PDAC).Methods.-We retrospectively analyzed patients with DA who underwent PD from 2008 to 2018 and assessed the accuracy rate of preoperative biopsy and factors associated with final malignant pathology. Complications for DA patients were compared with those of matched PDAC patients.Results.-Forty-five consecutive patients who underwent PD for DA were identified, and the preoperative biopsy false negative rate was 29. Factors associated with final malignant pathology included age over 70 years, preoperative biliary obstruction, and common bile duct diameter > 8 mm (p < 0.05). Compared with patients with PDAC (n = 302), DA patients experienced more major complications (31% vs. 15%, p < 0.01), more grade C postoperative pancreatic fistulas (9% vs. 1%, p < 0.01), and greater mortality (7% vs. 2%, p < 0.05). Propensity score matched patients with DA had more major complications following PD (32% vs. 12%, p < 0.05).Conclusions.-Preoperative biopsy of duodenal adenomas is associated with a high falsenegative rate for malignancy, and PD for DA is associated with higher complication rates than PD for PDAC. These results aid discussion among patients and surgeons who are considering observation versus PD for DA, especially in younger patients without biliary obstruction, who are less likely to harbor malignancy.Duodenal adenomas (DA) are premalignant tumors, representing < 0.12% of upper endoscopy findings, and are typically identified incidentally. 1 Adenomas larger than 20 mm, those with biopsy-proven high-grade dysplasia, and those involving the ampulla of Vater

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Section: Discussionsupporting

confidence: 92%

Relationship between Cancer Diagnosis and Complications Following Pancreatoduodenectomy for Duodenal Adenoma

et al. 2020

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“…Because of overlapping imaging features, the differentiation of PDAC from other mass-forming focal lesions in the pancreas can be difficult and leads to false-positive rates in 2%-35% of patients, causing unnecessary surgery and risk to patients (22). A broad range of nonneoplastic and neoplastic abnormalities can mimic PDAC, including focal acute and chronic pancreatitis, groove or paraduodenal pancreatitis, autoimmune pancreatitis, inflammatory pseudotumors, pancreatic acinar cell carcinoma, pancreatic endocrine tumors, and primary pancreatic lymphoma.…”

Section: Radiologic Featuresmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma and Its Variants: Pearls and Perils

Schawkat¹,

Manning²,

Glickman³

et al. 2020

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Pancreatic ductal adenocarcinoma (PDAC), an epithelial neoplasm derived from the pancreatic ductal tree, is the most common histologic type of pancreatic cancer and accounts for 85%-95% of all solid pancreatic tumors. As a highly lethal malignancy, it is the seventh leading cause of cancer death worldwide and is responsible for more than 300 000 deaths per year. PDAC is highly resistant to current therapies, affording patients a 5-year overall survival rate of only 7.2%. It is characterized histologically by its highly desmoplastic stroma embedding tubular and ductlike structures. On images, it typically manifests as a poorly defined hypoenhancing mass, causing ductal obstruction and vascular involvement. Little is known about the other histologic subtypes of PDAC, mainly because of their rarity and lack of specific patterns of disease manifestation. According to the World Health Organization, these variants include adenosquamous carcinoma, colloid carcinoma, hepatoid carcinoma, medullary carcinoma, signet ring cell carcinoma, undifferentiated carcinoma with osteoclast-like giant cells, and undifferentiated carcinoma. Depending on the subtype, they can confer a better or even worse prognosis than that of conventional PDAC. Thus, awareness of the existence and differentiation of these variants on the basis of imaging and histopathologic characteristics is crucial to guide clinical decision making for optimal treatment and patient management.

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“…Therefore, the postoperative pathological data are very valuable, especially those benign pancreatic cysts with surgical pathology 15 . Many cases of benign pancreatic cysts, such as SCN and MCN, are mistaken for malignant transformation or have undergone malignant transformation, or the patients strongly request surgery 16 . Some cases miss diagnosis in the past due to lack of advanced cross‐sectional imaging technology, but can get accurate diagnosis now with technical advances 3 .…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Patients With Surgically Resected Pancreatic Cysts: A Retrospective Analysis of 136 Patients

Gong

Wang

2022

J of Ultrasound Medicine

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Objectives-To retrospectively analyze the characteristics of pancreatic cysts with respect to histopathological diagnosis and various diagnostic imaging tools.Methods-The clinical features of 136 patients and characteristics of histopathologically diagnosed cysts were retrospectively assessed. The diagnostic accuracy of endoscopic ultrasound (EUS), computed tomography (CT), and magnetic resonance imaging (MRI) for pancreatic cysts was compared. Risk factors for high-grade dysplasia/invasive cancer in patients with intraductal papillary mucinous neoplasms (IPMNs) were also determined.Results-The final analysis included 30 serous cystic neoplasms (SCNs) (21.6%), 13 mucinous cystic neoplasms (MCNs) (9.4%), 65 IPMNs (46.8%), and 13 solid pseudopapillary neoplasms (SPNs) (9.4%). The percentage of women with MCNs, SPNs, SCNs, and IPMNs was 100.0, 76.9, 73.3, and 47.7%, respectively (P < .001). The percentages of patients over 60 years of age with IPMNs, SCNs, MCNs, and SPNs were 73.9, 23.3, 0, and 0%, respectively (P < .001). The percentage of cysts located in the body and tail of the pancreas in MCNs, SCNs, SPNs, and IPMNs was 100, 70, 53.9, and 46.2%, respectively (P < .001). A unique honeycomb appearance was observed in 26.7% of SCNs. The overall diagnostic accuracy of EUS, CT, and MRI for pancreatic cysts was 82.6, 72.5, and 73.9%, respectively. Lesion size and presence of solid components were independent predictors of high-risk IPMNs.Conclusions-Patient characteristics and cyst features can help to differentiate pancreatic cyst types and identify high-risk IPMNs. The diagnostic accuracy of EUS for pancreatic cysts is superior to that of CT and MRI.

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Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound

Cited by 16 publications

References 17 publications

Relationship between Cancer Diagnosis and Complications Following Pancreatoduodenectomy for Duodenal Adenoma

Relationship between Cancer Diagnosis and Complications Following Pancreatoduodenectomy for Duodenal Adenoma

Pancreatic Ductal Adenocarcinoma and Its Variants: Pearls and Perils

Clinical Characteristics of Patients With Surgically Resected Pancreatic Cysts: A Retrospective Analysis of 136 Patients

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