Clinical Study Of Imaging And Rapid Pathology In Diagnosis And Treatment Of Pancreatic Cystic Neoplasm

Objective:To investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm(PCN).Methods:The clinical data of 205 patients with PCN diagnosed by pathology from 2003 to 2018 were analyzed retrospectively.The accurate diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.Results:1.The most commonly used preoperative imaging methods were ultrasound and CT,in 146 cases(82.5%)and 141 cases(80.11%),respectively.There were 54 cases(30.68%)with MRI;75 cases were examined by single examination,most of them were detected by ultrasound,57 cases(76.00%).There were 101 cases of combined examination,of which 71 cases(70.30%)were examined by ultrasound combined with CT;The correct diagnostic rate of PCN by ultrasound,CT and MRI was 81.51%,81.56%and 87.04%respectively,and there was no statistical difference(?~2=0.950,P>0.05).But in accurate diagnosis,the diagnostic rate of ultrasound was3.42%,which was significantly lower than that of CT and MRI(16.31%and 16.37%,respectively),and the difference was statistically significant(?~2=14.559,P<0.01).2.In 27 cases of false diagnosis by ultrasound,no obvious abnormality was found in 51.85%,followed by misdiagnosis as pancreatic pseudocyst(40.74%);Of the 26 cases misdiagnosed as pancreatic cancer by CT,57.69%were misdiagnosed as pancreatic cancer;7 cases were misdiagnosed by MRI,42.86%of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst;31cases were misdiagnosed by intraoperative rapid pathology.And most of them misdiagnosed as pancreatic pseudocyst(32.26%);The next was SPN misdiagnosed as pancreatic neuroendocrine tumor(22.58%).3.The correct diagnostic rates of PCN were 80.68%,81.55%and 97.37%in preoperative imaging,intraoperative rapid pathology and preoperative imaging combined with intraoperative rapid pathology,while the misdiagnosis rates were 19.32%,18.45%and 2.63%,respectively.4.A total of 152 patients completed both preoperative imaging and intraoperative rapid pathology at the same time.Among them,34 cases(22.37%)were diagnosed accurately by imaging and 103 cases(67.76%)were diagnosed accurately by rapid pathological diagnosis.There was a statistical difference between the two groups(?~2=88.32,P<0.005).Conclusions:1.Ultrasound can be used as a primary screening method for PCN.Improving CT and MRI examination can further improve the accuracy of preoperative diagnosis,thus avoiding unreasonable surgical intervention measures.2.In the misdiagnosis of PCN,it is possible that ultrasound can not find the lesion of PCN,followed by misdiagnosis as pseudocyst of pancreas,CT and MRI were misdiagnosed as pancreatic carcinoma,and rapid intraoperative pathological examination misdiagnosed pancreatic pseudocyst as the most common,followed by SPN as pancreatic neuroendocrine tumor.Combined with clinical symptoms,hematuria amylase,tumor markers,intraoperative cystic fluid amylase and other laboratory examination can reduce misdiagnosis.3.Both preoperative imaging and intraoperative rapid pathology have a certain misdiagnosis rate.Improving preoperative imaging examination and combined with intraoperative rapid pathology can improve the correct diagnosis of PCN.The accurate diagnosis rate of intraoperative pathology is much higher than that of preoperative imaging.It is very important to improve the accurate diagnosis rate of PCN for the prognosis of patients.