Surgical treatment of incidentally identified pancreatic masses

With the improved quality and widespread availability of diagnostic abdominal imaging, incidental intra-abdominal lesions (incidentalomas) are being increasingly identified. Our objective was to characterize the clinical features of asymptomatic patients with incidentally discovered pancreatic lesions and to assess the accuracy of preoperative radiologic diagnosis against the final histologic diagnosis.

This cohort study is based on prospectively collected data from a surgical pancreatic database. Preoperative imaging of patients with pancreatic incidentalomas was retrospectively and independently assessed by 2 radiologists blinded to the final histologic diagnosis. Seven patients who were asymptomatic and had incidentally discovered pancreatic masses underwent complete resection of the mass. The clinical features and patient survival data were analyzed. The accuracy of preoperative imaging was assessed by comparing the preoperative diagnosis to the final histologic diagnosis.

Lesions most commonly occurred in females (6 patients) and in the tail or body of the pancreas (5 patients). The histologic type of the masses included neuroendocrine tumour (3), serous cystadenoma (2), intraductal papillary mucinous tumour (1) and papillary cystic and solid tumour (1). Preoperative imaging was unreliable in predicting the histologic type of the resected mass.

Our findings suggest that preoperative imaging does not always predict the surgical histologic type of pancreatic incidentalomas. Unless the diagnosis of serous cystadenoma is certain, surgical resection should be considered in low-risk patients in whom pancreatic masses are found incidentally.