Differential Diagnosis of Mucin-Producing Tumors of the Pancreas by Intraductal Ultrasonography and Peroral Pancreatoscopy

Abstract

Background and Study Aims: Although mucin producing tumors of the pancreas have been recently recognized as premalignant or malignant neoplasms, their diagnosis and management have been undetermined as yet. The aim of this study was to evaluate the capability of intraductal ultrasonography (IDUS) and peroral pancreatoscopy (PPS) in the differential diagnosis of mucin-producing tumors compared to that of other diagnostic tools.

Patients and Methods: From 1986 to 1997, 31 patients with mucin-producing tumors of the pancreas underwent surgery.

Results: Histologically, in patients with adenocarcinoma, papillary tumorous lesions within the pancreatic ducts were 3 mm or more in maximum height. The detection rates for such lesions were 29 % with US, 21 % with CT, 86 % with EUS, 100 % with IDUS and 83 % with PPS. In patients with adenocarelnoma, PPS revealed taller papillary lesions with redness and/or capillary vessels. Biopsy and cytology during ERCP and under PPS direct vision had a sensitivity of about 60 % in the differential diagnosis between malignancy and benign diseases.

Conclusions: Mucin-producing tumors of the pancreas with papillary tumorous lesions of 3 mm or more in maximum height should be considered as adenocarcinomas. The combined use of IDUS and PPS with biopsy and cytology is now considered the best for the differential diagnosis of mucin-producing tumors of the pancreas.