COMPUTED TOMOGRAPHIC AND CYTOLOGIC ASSESSMENT OF CYSTIC PANCREATIC NEOPLASMS - A DIFFICULT PREOPERATIVE DIAGNOSIS

The computed tomography (CT) findings or cytologic results, or both, f or 21 patients with cystic pancreatic neoplasm (4 with microcystic cys tadenoma, 6 with macrocystic mucinous cystadenoma, 10 with macrocystic mucinous cystadenocarcinoma and 1 with a papillary cystic neoplasm) w ere reviewed. CT scans for 14 of the patients were reviewed by two gas trointestinal radiologists who were blinded with respect to the patien ts' identities and the diagnoses. The radiologists used previously pub lished criteria for distinguishing between microcystic and macrocystic neoplasms. Of the four cases of microcystic cystadenoma, two were cor rectly diagnosed by one radiologist, and one was correctly diagnosed b y the other. Three and four cases respectively of five cases of macroc ystic 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 o f microcystic cystadenoma, two of four cases of macrocystic cystadenom a, five of seven cases of macrocystic cystadenocarcinoma and the papil lary cystic neoplasm were correctly diagnosed on the basis of the cyto logic findings. The combination of CT and cytologic assessment is help ful in distinguishing different types of cystic pancreatic neoplasms, but there is significant overlap among the clinical and radiographic f eatures of these lesions, and therefore operative assessment is often necessary.