Clinical Characteristics Help Diagnose
Cystic Lesions of the Pancreas
July 2004 Cancer Center News
A recent Medical College of Wisconsin study suggests that when managing patients with pancreatic cysts, accounting for the patient's age and clinical characteristics might be helpful. Specifically, surgical removal is recommended for pancreatic cysts that are symptomatic and are discovered in healthy older patients.
A recently published article Cystic Pancreatic Neoplasms—Observe or Operate (Annals of Surgery, May 2004; 239:5, 1-6) details the study led by Henry Pitt, MD (Surgery). Collaborators are Kristine Spinelli, MD (Radiology); Travis Fromwiller, MD (Radiology); Roger Daniel (Medical Student); James Kiely, MD (Surgery Research Fellow); Attila Nakeeb, MD (Surgery); Richard Komorowski, MD (Pathology); and Stuart Wilson, MD (Chief of Pancreatobiliary/Endocrinology Surgery).
Advancements in imaging technology have led to more frequent detection of cystic lesions of the pancreas. Many of the lesions start out small and non-cancerous or as the result of pancreatitis and may be observed. On the other hand, some may be, or lead to, a cystic neoplasm that should be surgically removed.
Because none of these imaging technologies is accurate enough to differentiate among the multiple benign, premalignant and malignant lesions, a study was done to help determine which patients can safely be observed and which should undergo surgery.
After analyzing data from 168 patients with pancreatic cysts who had CT or MR scans at Froedtert & Medical College of Wisconsin from 1995 to 2001 (none of whom had a clinical history and laboratory evidence of pancreatitis), researchers determined that age and presence of symptoms were indicators of neoplasm. Gender, cyst size and location within the pancreas were not.
In the study, the presence of symptoms predicted premalignant or malignant pathology. Of those with premalignant or malignant tumors, 60 percent had cystic tumor symptoms. Of those with benign cysts, 23 percent had symptoms.
The study also showed that older patients are more likely to have premalignant or malignant pancreatic cysts. The median age of patients with premalignant cysts was 60 years, and the median age of patients with malignant cysts was 75 years; whereas, the median age of patients with benign cysts was 50 years.
The findings of this study will help physicians and surgeons manage patients with pancreatic cysts by improving the available data to decide whether or not to operate.