NEW YORK (Reuters Health) Sep 18 - A substantial proportion of pancreatic "incidentalomas" - asymptomatic lesions detected incidentally -- are malignant or pre-malignant, Israeli researchers report in the September issue of the Journal of the American College of Surgeons.
Dr. Guy Lahat, at the MD Anderson Cancer Center, Houston, and his colleagues note that with improved technology, these lesions are being found more often. But, Dr. Lahat told Reuters Health, "clinicians all over the world still hesitate to refer their patients for pancreatic surgery due to its relatively high morbidity and mortality rates."
He and his team reviewed data on 475 pancreatectomies: 64 (13.5%) done for incidentalomas and 411 (86.5%) for symptomatic tumors.
Twenty-two of the subclinical lesions (34%) were malignant compared with 278 (68%) of the symptomatic tumors. However, 38 of the incidentalomas (59%) were pre-malignant, and only 4 (6%) carried little or no risk of progression.
Overall, the incidentaloma patients had a longer median disease-specific survival compared to those with symptomatic tumors (145 versus 46 months). In those with adenocarcinomas, the corresponding periods were 22 and 19 months.
Five-year disease-specific survival for patients treated for intrapapillary mucinous cystic tumor/mucinous cystadenoma was 94% with incidentalomas versus 68% with symptomatic tumors.
"The take home message," Dr. Lahat said, is that "incidental findings in the pancreas may not be innocent and therefore should be managed as potentially malignant until proven otherwise."
"Moreover," he concluded, "our data suggest that early intervention may prevent invasive cancer and improve survival."
J Am Coll Surg 2009;209:313-319.
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