Predictors of malignant potential of cystic lesions of the pancreas

Background: Cystic lesions of the pancreas (CLP) are a diagnostic dilemma, the correct characterisation of which determines surgical management. Methods: From 1995 to 2005, radiology and pathology records were reviewed for the presence of CLP. CLP were divided into three groups: Group 1: Benign, Group 2: Pre-malignant, and Group 3: Malignant. Results: Seventy-nine of 121 patients were included [Group 1: n = 46, Group 2: n = 10, Group 3: n = 23], with a median age at diagnosis of 68 (31-92) years. The median follow-up period was 24 (14-84) months. On univariate analysis, female gender (p = 0.04), jaundice (p < 0.01), raised serum ALT concentration (p = 0.03), cyst size (>= 2.5 cm) (p < 0.01), and biliary duct dilatation (p < 0.01) were associated with malignant potential. Benign cysts were more likely to present incidentally (p < 0.01). On multi-variate analysis, cyst size (>= 2.5 cm) was an independent predictor of malignant potential. Sub-group analysis revealed that cysts < 2.5 cm in the head of the pancreas with evidence of biliary obstruction (either abnormal liver function; raised ALT [p = 0.01] ALP [p = 0.01], total bilirubin [p = 0.02], and/ or biliary duct dilatation [p < 0.01]) were associated with malignant potential. Conclusion: Cyst size >= 2.5 cm on computer tomography imaging was an independent predictor of pre-malignant and malignant pancreatic cysts. Cyst size and the presence of biliary obstruction predict potentially malignant cysts of the head of the pancreas, which require surgical management. (c) 2007 Elsevier Ltd. All rights reserved.