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Is FDG-PET helpful in differentiating between benign and malignant branch type IPMN?
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Abstracts / Pancreatology 13 (2013) S1–S80
was revealed as mucinous cystadenoma. On follow up CT scan that has taken 3 months after excision, there was a recurred mass 5cm in size at pancreas head and additional mass surrounding celiac trunk with internal calcification. At this time we performed PPPD and excision of the firm mass surrounding celiac trunk. Histopathological examination showed mucinous cystic tumor for the pancreatic head mass and malignant peripheral nerve tumor for the firm celiac trunk that invaded to pancreas head, common bile duct and celiac trunk. Four months after second operation, recurrence was occurred around mesentery, aortocaval region and at hepatic surface of right liver. The patient was dead 8 months after second operation due to metastasis. Conclusion: Malignant peripheral nerve sheath tumor around celiac trunk combined with mucinous cystic tumor of the pancreas head was completely resected. However the patient showed poor prognosis with early recurrence and died 8 months after surgery. Keywords: Pancreas cancer, Peripheral nerve sheath tumor
[P-112]. Is FDG-PET helpful in differentiating between benign and malignant branch type IPMN? Tsukasa Ikeura, Makoto Takaoka, Kazushige Uchida, Masaaki Shimatani, Hideaki Miyoshi, Kazuichi Okazaki The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan Background/aim: The potential role of FDG-PET in differentiating between benign and malignant branch type IPMN is fully unknown. This study was conducted to evaluate the possibility of correctly differentiating between benign and malignant IPMN by FDG-PET and to determine whether FDG-PET enhances the accuracy of the international consensus guidelines 2012 of IPMN (ICG). Methods: We retrospectively reviewed 66 patients histologically proven as IPMN based on resected specimen. Of these patients, 37 patients (21 males and 16 females, mean age at the surgery 70.6 4.7 years) who had undergone FDG-PET preoperatively were studied. FDG-PET was analyzed visually and semi-quantitatively using the standard uptake value (SUV). A focal uptake with a SUV of 2.5 or greater was concerned positive. Results: The histological diagnosis was malignancy in 20 patients (invasive IPMN in 4 and non-invasive IPMN in 16) and benign in 17 patients. The histological diagnosis of patients showing a positive uptake of FDG was invasive IPMN in 3 patients, non-invasive IPMN in 2, adenoma in 1, while that of patients without a positive uptake is invasive IPMN in 1, non-invasive IPMN in 14 and adenoma in 16. Therefore, sensitivity, specificity, and accuracy of FDG-PET for distinguishing between benign and malignant IPMN were 25%, 94%, and 57%, respectively. On the other hand, sensitivity, specificity, and accuracy of ICG were 90%, 41%, and 68%, respectively. All patients with malignant IPMN showing a positive uptake of FDG were considered for resection according to ICG. Conclusions: FDG-PET is unhelpful in differentiating between benign and malignant branch type IPMN, and does not enhance the accuracy of ICG. Keywords: IPMN, FDG-PET, International consensus guidelines, Diagnosis
Background/aim: Diagnostic errors in the preoperative evaluation of cystic neoplasm of the pancreas (CNP) are not uncommon. Only limited data is available regarding the impact of these errors on clinical management. Aim: This study aims to evaluate the clinical impact of these diagnostic errors. Methods: A series of 141 patients undergoing surgery for CNP at Karolinska University Hospital was retrospectively analyzed. There were 60 males and 81 females; the mean age was 60.3 yrs. CT was performed in 138 patients (97.8%), MR in 85 (60.3%), and EUS in 31 (21.9%). Results: Histology confirmed the pre-operative diagnosis in 60.9% of patients. The concordance rate between pre-operative diagnosis and histology was similar for asymptomatic and symptomatic lesions (60.5% vs 61.4%; p¼NS). The rate of correct diagnosis increased over time (2004–2006: 54.5%, 2007–2012: 61.7%, 2010–2012: 63.5%). Lymphoepithelial cysts (2/2) were misdiagnosed most frequently, followed by serous cystic neoplasia (24/33, 72.2%), solid pseudopapillary neoplasia (5/8, 62.5%), mucinous cystic neoplasia (7/25, 28%), and IPMN (17/56, 23.3%). Reevaluating the surgical indication in view of the histological diagnosis, surgical resection was not required in 13 patients (9.2%). There was no mortality in this patient group, and morbidity amounted to 53.8%. Conclusions: The results confirm that preoperative diagnostic errors are quite common in CNP, however, the percentage of patients who unnecessarily undergo surgery is low (9.2%). The error rate is similar for symptomatic and asymptomatic patients. Keywords: Cystic tumors, Pancreas tumors, IPMN, Diagnostic errors, Pancreas cancer
[P-114]. Three cases of laparo-assisted pancreatectomy Satoru Takayama, Yuichi Hayashi, Hiroyuki Imafuji, Shingo Nagai, Masaki Sakamoto, Hisanori Kani Endoscopic Surgery Center, Nagoya Tokusyukai General Hospital, Kasugai, Japan Contents: Now a days, there are some reports that indicate laparoscopic distal pancreatectomy is feasible. This time we have experienced two laparo-assisted pancreatectomy and one total pancreatectomy. Therefore here we report three cases of less invasive pancreatectomy. The first case was the 59-year-old man with IPMA at the pancreatic body. The second case was the 41-year-old female with MCA at the pancreatic body. The third case was the 70-year-old female with IPMC at whole pancreas. All of them were performed complete splenic mobilization in advance. Then distal pancreas was mobilized by laparoscopically by LCS. In the total pancreatectomy case, laparoscopic cholecystectomy is performed additionally. Then the first and the second cases, the distal side of pancreas were cut by End-GIA. And finally resected specimen were removed from upper medial small incision. The third case, residual pancreatic head resection and reconstruction was also performed upper medial small insicion. As the result, although in the distal pancreatomy case, the leakage of pancreatic juice were noted. The other complications which derived from this methodology were not happen. Mainly because of splenectomy, we need large incision in case of pancreatectomy. But once splenectomy is performed laparoscopically, we do not need such a large incision. Therefore laparo-assisted pancreatectomy is feasible for such kinds of pancreatic cystic lesion. Keywords: Laparoscopy, Pancreatic cystic lesion
[P-113]. Diagnostic errors in cystic neoplasms of the pancreas Marco Del Chiaro 1, Caroline Verbeke 2, Elena Rangelova 1, €rd 1 Christoph Ansorge 1, John Blomberg 1, Nils Albiin 3, Ralf Segersva 1
Department of Surgery, Karolinska Institute, Stockholm, Sweden Department of Pathology, Karolinska Institute, Stockholm, Sweden 3 Department of Radiology, Karolinska Institute, Stockholm, Sweden 2
[P-115]. The clinical outcome of incidental pancreatic cystic neoplasms in patients over 65 years old: Follow up or surgical resection? Hyo Jung Kim 1, Sung Ho Kim 1, Yong Jeoung 2, Jae Min Lee 2, Jungwan Choe 1, So Yeon Kim 1, Moon Kyung Joo 1, Beom Jae Lee 1,
Abstracts / Pancreatology 13 (2013) S1–S80
was revealed as mucinous cystadenoma. On follow up CT scan that has taken 3 months after excision, there was a recurred mass 5cm in size at pancreas head and additional mass surrounding celiac trunk with internal calcification. At this time we performed PPPD and excision of the firm mass surrounding celiac trunk. Histopathological examination showed mucinous cystic tumor for the pancreatic head mass and malignant peripheral nerve tumor for the firm celiac trunk that invaded to pancreas head, common bile duct and celiac trunk. Four months after second operation, recurrence was occurred around mesentery, aortocaval region and at hepatic surface of right liver. The patient was dead 8 months after second operation due to metastasis. Conclusion: Malignant peripheral nerve sheath tumor around celiac trunk combined with mucinous cystic tumor of the pancreas head was completely resected. However the patient showed poor prognosis with early recurrence and died 8 months after surgery. Keywords: Pancreas cancer, Peripheral nerve sheath tumor
[P-112]. Is FDG-PET helpful in differentiating between benign and malignant branch type IPMN? Tsukasa Ikeura, Makoto Takaoka, Kazushige Uchida, Masaaki Shimatani, Hideaki Miyoshi, Kazuichi Okazaki The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan Background/aim: The potential role of FDG-PET in differentiating between benign and malignant branch type IPMN is fully unknown. This study was conducted to evaluate the possibility of correctly differentiating between benign and malignant IPMN by FDG-PET and to determine whether FDG-PET enhances the accuracy of the international consensus guidelines 2012 of IPMN (ICG). Methods: We retrospectively reviewed 66 patients histologically proven as IPMN based on resected specimen. Of these patients, 37 patients (21 males and 16 females, mean age at the surgery 70.6 4.7 years) who had undergone FDG-PET preoperatively were studied. FDG-PET was analyzed visually and semi-quantitatively using the standard uptake value (SUV). A focal uptake with a SUV of 2.5 or greater was concerned positive. Results: The histological diagnosis was malignancy in 20 patients (invasive IPMN in 4 and non-invasive IPMN in 16) and benign in 17 patients. The histological diagnosis of patients showing a positive uptake of FDG was invasive IPMN in 3 patients, non-invasive IPMN in 2, adenoma in 1, while that of patients without a positive uptake is invasive IPMN in 1, non-invasive IPMN in 14 and adenoma in 16. Therefore, sensitivity, specificity, and accuracy of FDG-PET for distinguishing between benign and malignant IPMN were 25%, 94%, and 57%, respectively. On the other hand, sensitivity, specificity, and accuracy of ICG were 90%, 41%, and 68%, respectively. All patients with malignant IPMN showing a positive uptake of FDG were considered for resection according to ICG. Conclusions: FDG-PET is unhelpful in differentiating between benign and malignant branch type IPMN, and does not enhance the accuracy of ICG. Keywords: IPMN, FDG-PET, International consensus guidelines, Diagnosis
Background/aim: Diagnostic errors in the preoperative evaluation of cystic neoplasm of the pancreas (CNP) are not uncommon. Only limited data is available regarding the impact of these errors on clinical management. Aim: This study aims to evaluate the clinical impact of these diagnostic errors. Methods: A series of 141 patients undergoing surgery for CNP at Karolinska University Hospital was retrospectively analyzed. There were 60 males and 81 females; the mean age was 60.3 yrs. CT was performed in 138 patients (97.8%), MR in 85 (60.3%), and EUS in 31 (21.9%). Results: Histology confirmed the pre-operative diagnosis in 60.9% of patients. The concordance rate between pre-operative diagnosis and histology was similar for asymptomatic and symptomatic lesions (60.5% vs 61.4%; p¼NS). The rate of correct diagnosis increased over time (2004–2006: 54.5%, 2007–2012: 61.7%, 2010–2012: 63.5%). Lymphoepithelial cysts (2/2) were misdiagnosed most frequently, followed by serous cystic neoplasia (24/33, 72.2%), solid pseudopapillary neoplasia (5/8, 62.5%), mucinous cystic neoplasia (7/25, 28%), and IPMN (17/56, 23.3%). Reevaluating the surgical indication in view of the histological diagnosis, surgical resection was not required in 13 patients (9.2%). There was no mortality in this patient group, and morbidity amounted to 53.8%. Conclusions: The results confirm that preoperative diagnostic errors are quite common in CNP, however, the percentage of patients who unnecessarily undergo surgery is low (9.2%). The error rate is similar for symptomatic and asymptomatic patients. Keywords: Cystic tumors, Pancreas tumors, IPMN, Diagnostic errors, Pancreas cancer
[P-114]. Three cases of laparo-assisted pancreatectomy Satoru Takayama, Yuichi Hayashi, Hiroyuki Imafuji, Shingo Nagai, Masaki Sakamoto, Hisanori Kani Endoscopic Surgery Center, Nagoya Tokusyukai General Hospital, Kasugai, Japan Contents: Now a days, there are some reports that indicate laparoscopic distal pancreatectomy is feasible. This time we have experienced two laparo-assisted pancreatectomy and one total pancreatectomy. Therefore here we report three cases of less invasive pancreatectomy. The first case was the 59-year-old man with IPMA at the pancreatic body. The second case was the 41-year-old female with MCA at the pancreatic body. The third case was the 70-year-old female with IPMC at whole pancreas. All of them were performed complete splenic mobilization in advance. Then distal pancreas was mobilized by laparoscopically by LCS. In the total pancreatectomy case, laparoscopic cholecystectomy is performed additionally. Then the first and the second cases, the distal side of pancreas were cut by End-GIA. And finally resected specimen were removed from upper medial small incision. The third case, residual pancreatic head resection and reconstruction was also performed upper medial small insicion. As the result, although in the distal pancreatomy case, the leakage of pancreatic juice were noted. The other complications which derived from this methodology were not happen. Mainly because of splenectomy, we need large incision in case of pancreatectomy. But once splenectomy is performed laparoscopically, we do not need such a large incision. Therefore laparo-assisted pancreatectomy is feasible for such kinds of pancreatic cystic lesion. Keywords: Laparoscopy, Pancreatic cystic lesion
[P-113]. Diagnostic errors in cystic neoplasms of the pancreas Marco Del Chiaro 1, Caroline Verbeke 2, Elena Rangelova 1, €rd 1 Christoph Ansorge 1, John Blomberg 1, Nils Albiin 3, Ralf Segersva 1
Department of Surgery, Karolinska Institute, Stockholm, Sweden Department of Pathology, Karolinska Institute, Stockholm, Sweden 3 Department of Radiology, Karolinska Institute, Stockholm, Sweden 2
[P-115]. The clinical outcome of incidental pancreatic cystic neoplasms in patients over 65 years old: Follow up or surgical resection? Hyo Jung Kim 1, Sung Ho Kim 1, Yong Jeoung 2, Jae Min Lee 2, Jungwan Choe 1, So Yeon Kim 1, Moon Kyung Joo 1, Beom Jae Lee 1,