Nonoperative management of pancreatic pseudocyts - Problems in differential diagnosis

Background. The accurate diagnosis of pancreatic cystic lesions remains a p roblem. The aim of this study was to ascertain the incidence of and the rea sons the diagnostic errors occurred in a series of pseudocysts drained perc utaneously and to compare these data to those reported in the literature. Methods, Data from 70 patients bearing one or more pseudocysts who underwen t a percutaneous drainage were reviewed. The pretreatment workup included m edical history, physical examination, ultrasound (US) and computed tomograp hy (CT) scans, amylase assay in both the serum and the cystic fluid, cultur e and cytology of the cystic fluid. After removal of the drainage, the mini mum follow-up period was 12 mo. Results. Four patients died, and two cancer-associated pseudocysts were ide ntified before removal of the drainage. Sixty-four patients were followed u p for a mean of 51.9 mo (range 12-154 mel). A third cancer and a mucinous c ystic tumor, fully communicating with the main duct, were further detected during this period. bConclusion. The evaluation of pancreatic cystic lesions entails a misdiagn osis risk. Awareness of the problem, knowledge of the natural history of th ese lesions, and meticulous posttreatment followup can reduce the consequen ces of diagnostic errors, If all these precautions are adopted, pancreatic pseudocysts can be safely treated nonoperatively.