Computed tomographic and cytologic assessment of cystic pancreatic neoplasms: a difficult preoperative diagnosis

The computed tomography (CT) findings or cytologic results, or both, for 21 patients with cystic pancreatic neoplasm (4 with microcystic cystadenoma, 6 with macrocystic mucinous cystadenoma, 10 with macrocystic mucinous cystadenocarcinoma and 1 with a papillary cystic neoplasm) were reviewed. CT scans for 14 of the patients were reviewed by two gastrointestinal radiologists who were blinded with respect to the patients' identities and the diagnoses. The radiologists used previously published criteria for distinguishing between microcystic and macrocystic neoplasms. Of the four cases of microcystic cystadenoma, two were correctly diagnosed by one radiologist, and one was correctly diagnosed by the other. Three and four cases respectively of five cases of macrocystic cystadenoma were correctly identified, as were three and five of five cases of macrocystic cystadenocarcinoma. Cytologic evaluation of samples from fine-needle aspiration biopsy had been performed for 15 of the patients, and these records were reviewed. One of three cases of microcystic cystadenoma, two of four cases of macrocystic cystadenoma, five of seven cases of macrocystic cystadenocarcinoma and the papillary cystic neoplasm were correctly diagnosed on the basis of the cytologic findings. The combination of CT and cytologic assessment is helpful in distinguishing different types of cystic pancreatic neoplasms, but there is significant overlap among the clinical and radiographic features of these lesions, and therefore operative assessment is often necessary.