Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients.
Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients.
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DOI：
10.1001/archsurg.138.4.427
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发表时间：
2003-04
影响因子：
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通讯作者：
C. F. Fernandez-Del Castillo;J. Targarona;S. Thayer;D. Rattner;W. Brugge;A. Warshaw
中科院分区：
文献类型：
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作者：
C. F. Fernandez-Del Castillo;J. Targarona;S. Thayer;D. Rattner;W. Brugge;A. Warshaw
假设计算机断层扫描和超声的广泛使用导致越来越多的无症状胰腺囊性病变患者的识别。设计：胰腺囊性病变患者回顾性病例系列。大学附属三级医疗转诊中心。患者：5年来（1997年4月- 2002年3月）共收治了212例胰腺囊性病变患者。主要观察指标：有无症状、囊肿大小和位置、细胞学或病理学诊断、手术治疗和结果。结果212例患者中78例（36.7%）无症状。偶发囊肿较小（3.3 +/- 1.9 vs 4.6 +/- 2.7 cm； P<.001），见于老年患者（65 +/- 13 vs 56 +/- 15岁；P<.001）。78%的无症状患者和87%的有症状患者接受了手术，整个组中有一例手术死亡（0.5%）。17%的无症状囊肿为浆液性囊腺瘤；粘液囊性肿瘤28%；27%为导管内乳头状粘液瘤；2.5%为导管腺癌。有症状的囊肿分别为7%、16%、40%和9%。10%的无症状患者有多种其他囊性病变，12%的患者没有明确的细胞学或病理学诊断。总体而言，17%的无症状患者患有原位或侵袭性癌症，42%的患者患有癌前病变。当作为大小的函数进行评估时，28个小于2cm的无症状囊肿中只有1个（3.5%）为癌症，而50个大于2cm的囊肿中有13个（26%）为癌症（P = 0.04）。然而，两组的癌前病变比例仍然很高（分别为46%和38%）。假性囊肿仅占无症状囊肿的3.8%，而有症状囊肿占19.4% （P = 0.003）。结论：偶发胰腺囊肿很常见，常见于老年患者，小于有症状的囊肿，不太可能是假性囊肿。其中一半以上是恶性或癌前病变，因此不能被排除。
HYPOTHESIS Widespread use of computed tomography and ultrasound has led to the identification of increasing numbers of patients with asymptomatic cystic lesions of the pancreas. DESIGN Retrospective case series of patients with pancreatic cystic lesions. SETTING University-affiliated tertiary care referral center. PATIENTS Two hundred twelve patients with pancreatic cystic lesions seen in our surgical practice during 5 years (April 1997-March 2002). MAIN OUTCOME MEASURES Presence or absence of symptoms, cyst size and location, cytologic or pathologic diagnosis, surgical treatment, and outcome. RESULTS Seventy-eight (36.7%) of 212 patients were asymptomatic. Incidental cysts were smaller (3.3 +/- 1.9 vs 4.6 +/- 2.7 cm; P<.001) and were found in older patients (65 +/- 13 vs 56 +/- 15 years; P<.001). Seventy-eight percent of the asymptomatic patients and 87% of those with symptoms underwent surgery, with a single operative death in the entire group (0.5%). Seventeen percent of asymptomatic cysts were serous cystadenomas; 28%, mucinous cystic neoplasms; 27%, intraductal papillary mucinous neoplasms; and 2.5%, ductal adenocarcinomas. The respective numbers for symptomatic cysts were 7%, 16%, 40%, and 9%. Ten percent of asymptomatic patients had a variety of other cystic lesions, and in 12%, no definitive cytologic or pathologic diagnosis was obtained. Overall, 17% of asymptomatic patients had in situ or invasive cancer, and 42% had a premalignant lesion. When evaluated as a function of size, only 1 (3.5%) of 28 asymptomatic cysts smaller than 2 cm had cancer compared with 13 (26%) of 50 cysts larger than 2 cm (P =.04). The proportion of premalignant lesions, however, remained high in both groups (46% and 38%, respectively). Pseudocysts comprised only 3.8% of asymptomatic cysts compared with 19.4% of symptomatic cysts (P =.003). CONCLUSIONS Incidental pancreatic cysts are common, occur in older patients, are smaller than symptomatic cysts, and are unlikely to be pseudocysts. More than half of them are either malignant or premalignant lesions and therefore cannot be dismissed.