Start Over

Differential diagnosis of small solid pancreatic lesions.

Authors :: Dietrich CF
Sahai AV
D'Onofrio M
Will U
Arcidiacono PG
Petrone MC
Hocke M
Braden B
Burmester E
Möller K
Săftoiu A
Ignee A
Cui XW
Iordache S
Potthoff A
Iglesias-Garcia J
Fusaroli P
Dong Y
Jenssen C
Source :: Gastrointestinal endoscopy [Gastrointest Endosc] 2016 Dec; Vol. 84 (6), pp. 933-940. Date of Electronic Publication: 2016 May 04.
Publication Year :: 2016
Abstract: Background and Aims: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management.<br />Methods: Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients.<br />Results: The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%).<br />Conclusions: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.<br /> (Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)