Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy.
Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy.
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DOI：
10.1245/s10434-013-2986-6
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发表时间：
2013-09
影响因子：
3.7
通讯作者：
Weber SM
中科院分区：
文献类型：
--
作者：
Cho CS;Russ AJ;Loeffler AG;Rettammel RJ;Oudheusden G;Winslow ER;Weber SM
不同的胰腺囊性肿瘤(PCN)亚型恶变的可能性不同。影像和囊液分析被用来识别需要手术切除的癌前或恶性病例，但手术决策过程的准确性尚不清楚。这项研究的目的是确定PCN的误诊特征，并确定良性、非癌前疾病进行手术的频率。对因术前诊断为PCN而行胰腺切除术的患者进行了回顾性分析。比较术前诊断和病理诊断，以衡量诊断的准确性。1999年至2011年间，74名患者因术前诊断为PCN而接受胰腺切除术。术前粘液性PCN与非粘液性PCN的分类准确率为74%。特异术前PCN诊断正确率为47%，但半数不正确的术前诊断与病理诊断相当。病理诊断恶性潜能高于术前诊断的可能性为7%。20%的病例术前诊断为癌前或恶性，而病理诊断为良性。使用EUS或在本分析的时间段内，诊断准确率以及欠呼叫诊断和超呼手术的比率没有变化。准确的术前PCN分类经常是不正确的，但在四分之三的病例中会导致适当的临床决策。然而，五分之一的胰腺切除是为良性疾病而进行的，没有恶性的可能性。对误诊率的认识应该有助于我们对PCN的手术治疗。
The potential for malignant transformation varies among pancreatic cystic neoplasms (PCN) subtypes. Imaging and cyst fluid analysis are used to identify premalignant or malignant cases that should undergo operative resection, but the accuracy of operative decision-making process is unclear. The objective of this study was to characterize misdiagnoses of PCN and determine how often operations are undertaken for benign, non-premalignant disease. A retrospective analysis of patients undergoing pancreatic resection for the preoperative diagnosis of PCN was undertaken. Preoperative and pathological diagnoses were compared to measure diagnostic accuracy. Between 1999 and 2011, 74 patients underwent pancreatic resection for the preoperative diagnosis of PCN. Preoperative classification of mucinous vs. non-mucinous PCN was correct in 74 %. The specific preoperative PCN diagnosis was correct in 47 %, but half of incorrect preoperative diagnoses were clinically equivalent to the pathological diagnoses. The likelihood that the pathological diagnosis was of higher malignant potential than the preoperative diagnosis was 7 %. In 20 % of cases, the preoperative diagnosis was premalignant or malignant, but the pathological diagnosis was benign. Diagnostic accuracy and the rate of undercall diagnoses and overcall operations did not change with the use of EUS or during the time period of this analysis. Precise, preoperative classification of PCN is frequently incorrect but results in appropriate clinical decision-making in three-quarters of cases. However, one in five pancreatic resections performed for PCN was for benign disease with no malignant potential. An appreciation for the rate of diagnostic inaccuracies should inform our operative management of PCN.