Pancreatic Cystic Lesions- Imaging Based Classification and Proposal for Therapeutic Guidelines

Introduction: Because of the growing use of cross-sectional imaging, cystic lesions of the pancreas are becoming more often detected. As a result, it’s critical to identify cystic neoplasms from pseudocysts and to describe cystic neoplasms of the pancreas.

The goal of this study is to develop a categorization system for cystic pancreatic lesions based on the morphologic characteristics of the lesions. This approach can assist in identifying lesions, narrowing the differential diagnosis, and determining therapy decisions for affected individuals.

Materials and Methods: A total of 56 people (27 men and 29 women) were included in the study, all of whom had cystic pancreatic lesions as their final diagnosis. The following materials were used in the project: MDCT investigations were performed with a 16-slice scanner and ultrasonic equipment with 3.5 and 7 MHz linear, convex, and biopsical transducers. Images are taken during the pancreatic and portal venous phases of contrast enhancement. The “Chiba” needles (18, 20, 22, 23G), the automatic aspiration system, and techniques of guiding interventional treatments are all available.

Discussion and Conclusions: All 56 patients in this study had at least two cuts imaging survey modalities conducted, such as US, CT, or MRI. The most prevalent preoperative diagnostic examination was a US scan, which was performed in 56 patients (100%), followed by MDCT investigations in 49 patients (87.50%) and MRI in 13 patients (23.21 percent ). As part of the assessment, more than half of the patients (37) had some form of interventional procedure: 25-FNA and 29-FNAB. After the FNAB for cystic lesions of the pancreas, 34 of the 56 patients were operated on because to histological evidence of malignancy. We calculated the diagnostic power of diagnostic imaging modalities for cystic lesions of the pancreas by comparing the diagnostic results of US examination with those of MDCT examination and histological verification. The results showed that the specificity was 68.75 percent, the sensitivity was 79.48 percent, the accuracy was 75.00 percent, the positive predictive value was 86.11 percent, and the negative predictive value was 55 percent. After invasive procedures and immunohistochemistry examination of CEA and P-53, the power rose. In 34 (60.71 percent) of instances, the need for surgery was established by histological verification in patients with clear symptoms and/or clear imaging signs of malignant or premalignant cystic neoplasm.

Conclusions: If the proposed methodology had been used, cystic mucinous tumours of the pancreas could have been detected and correct operative procedures could have been conducted with fewer diagnostic exams.

Author (s) Details

A. Hilendarov
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

K. Velkova
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

A. Nedeva
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

E. Simova
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

P. Stefanov
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

A. Todorov
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

D. Psomas
Department of Diagnostic Imaging, Medical University, Plovdiv, Bulgaria.

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