Abstract
BackgroundCharacterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them.ObjectivesThe aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard.MethodA total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings.ResultsSerous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5%ConclusionThe diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought.
Highlights
Pancreatic lesions can be either solid, cystic or solid–cystic in nature, either of which can be benign, borderline or malignant
Of the 38 patients diagnosed with cystic pancreatic lesions on imaging, 12 patients (31.6%) had Serous cystadenomas (SCAs), 10 patients (26.3%) had mucinous cystadenomas (MCA), 8 (21.1%) had solid pseudo-papillary tumours (SPT), 4 (10.5%) patients had intra-ductal papillary mucinous neoplasms (IPMN), 3 patients (7.9%) had simple cysts and 1 patient (2.6%) had a lymphangioma
Serous cystadenoma was the most common cystic pancreatic lesion found in 31.6% of patients in our study followed by MCA (26.3%), SPT (21.1%) and IPMN (10.5%)
Summary
Pancreatic lesions can be either solid, cystic or solid–cystic in nature, either of which can be benign, borderline or malignant. Serous cystadenomas (SCAs), mucinous cystic neoplasms and intra-ductal papillary mucinous neoplasms constitute more than 90% of primary cystic pancreatic neoplasms.[2] Simple cysts and SCAs are benign and, if asymptomatic, can be safely followed. Mucinous neoplasms are potentially malignant, justifying their surgical resection.[1,2,3] Cystic pancreatic lesions are usually found incidentally on imaging studies performed for other reasons, and as many as 35% of patients are totally asymptomatic at the time of diagnosis.[1,2,3] http://www.sajr.org.za. Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them
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