Cystic tumors of the pancreas: preoperative imaging,diagnosis, and treatment

The objective of this retrospective study was to explore the accuracy of preoperative diagnostic methods and the efficacy of treatment for cystic pancreatic tumors. From 1989 to 1999, 18 patients underwent surgery for cystic tumor of the pancreas, classified as follows: one serous cystadenoma, eight mucinous cystadenomas, six mucinous cystadenocarcinomas, and three nonfunctioning islet cell tumors. Computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and fine needle aspiration were performed and subsequently reviewed retrospectively by two radiologists. Three patients underwent the Whipple procedure and 14 and 1 patients underwent distal and central pancreatectomy, respectively. CT showed cystic pancreatic tumors in all cases. One case was misdiagnosed as a pseudocyst. The diagnosis was accurate in 82%, 53%, 37%, and 60% of cases on CT, ERCP, and angiography, and in the cytologic analysis of the aspirated fluid, respectively. All operative procedures were performed without significant morbidity and there were no postoperative deaths. Preoperative diagnosis of cystic pancreatic tumours is imprecise. CT is the most reliable preoperative imaging method. Resection should be the treatment of choice for these lesions, except in cases of serous cystadenoma.