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8. Differential diagnosis of small solid pancreatic lesions

Author

Eike Burmester, Julio Iglesias-Garcia, Mirko D'Onofrio, Barbara Braden, Yi Dong, Sevastita Iordache, Maria Chiara Petrone, Christian Jenssen, Anand V. Sahai, Pietro Fusaroli, Xin-Wu Cui, Andrej Potthoff, Adrian Saftoiu, Uwe Will, Andre Ignee, Kathleen Möller, Michael Hocke, Paolo Giorgio Arcidiacono, Christoph F. Dietrich, Dietrich, Christoph Frank, Sahai, Anand Vasante, D'Onofrio, Mirko, Will, Uwe, Arcidiacono, Paolo Giorgio, Petrone, Maria Chiara, Hocke, Michael, Braden, Barbara, Burmester, Eike, Möller, Kathleen, Săftoiu, Adrian, Ignee, Andre, Cui, Xin-Wu, Iordache, Sevastita, Potthoff, Andrej, Iglesias-Garcia, Julio, Fusaroli, Pietro, Dong, Yi, Jenssen, Christian, Dietrich, Cf, Sahai, Av, D'Onofrio, M, Will, U, Arcidiacono, P. G., 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, and Jenssen, C.

Subjects
Male, Solid pancreatic lesions (SPLs), endocrine system diseases, Contrast Media, pancreatic ductal adenocarcinoma (PDAC), Neuroendocrine tumors, Endosonography, 0302 clinical medicine, Stage (cooking), fine-needle aspiration (FNA), Aged, 80 and over, Incidental Findings, medicine.diagnostic_test, Gastroenterology, Middle Aged, contrast agent, Magnetic Resonance Imaging, Tumor Burden, Neuroendocrine Tumors, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, pancreatic tumor, 030211 gastroenterology & hepatology, Radiology, Pancreas, Carcinoma, Pancreatic Ductal, Adult, medicine.medical_specialty, Adolescent, Diagnosis, Differential, Young Adult, 03 medical and health sciences, contrast-enhanced endoscopic ultrasound (CE-EUS), Biopsy, medicine, Carcinoma, Humans, Radiology, Nuclear Medicine and imaging, endoscopic ultrasound (EUS), Radical surgery, Aged, Retrospective Studies, business.industry, Retrospective cohort study, medicine.disease, digestive system diseases, Pancreatic Neoplasms, Differential diagnosis, Tomography, X-Ray Computed, business
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. 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. 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%). 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.

Published
2016

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