Combined method for differential diagnosis of pancreatic cystic neoplasm

Abstract

Objective. The frequency of detection of cystic neoplasm of the pancreas (CNP) has recently increased. Some of these neoplasms are benign, while others are malignant. Differential diagnosis between benign and malignant CNP remains challenging.Aim: to develop a combined method for differential diagnosis of CNP and to evaluate the role of the neutrophil to leukocyte ratio (NLR) as a diagnostic criterion of malignant CNP.Material and Methods. A retrospective analysis of the treatment of 82 patients with CNP, who underwent surgery between 2008 and 2018, was carried out. Benign lesions were detected in 62 patients and malignant tumors were diagnosed in 20 patients. The NLR and the serum levels of CA 19-9 as well as the presence of intracystic lesions were assessed as predictors of malignant CNP.Results. The presence of intracystic lesions detected by contrast-enhanced computed tomography and the elevated levels of serum CA 19-9 (>39 U/mL) and NLI (>1.876) were proven to be independent predictors of malignant CNP with statistical significance. The combination of all three criteria indicated malignant cystic neoplasm. The sensitivity, specificity and overall accuracy of the combined method were 71.4 %, 95.6 % and 86.5%, respectively.Conclusions. The combined method for differential diagnosis of malignant CNP is easy to use and has high accuracy. There is a direct correlation between NLI and malignant CNP.