Differential diagnosis of small solid pancreatic lesions

Christoph Frank Dietrich, Anand Vasante Sahai, Mirko D'Onofrio, Uwe Will, Paolo Arcidiacono, Maria Chiara Petrone, Michael Hocke, Barbara Braden, Eike Burmester, Kathleen Möller, Adrian Săftoiu, Andre Ignee, Xin Wu Cui, Sevastita Iordache, Andrej Potthoff, Julio Iglesias-Garcia, Pietro Fusaroli, Yi Dong, Christian Jenssen

Research output: Contribution to journalArticlepeer-review


Background and Aims Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management. Methods Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients. Results The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). Conclusions Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.

Original languageEnglish
Pages (from-to)933-940
Number of pages8
JournalGastrointestinal Endoscopy
Issue number6
Publication statusPublished - Dec 1 2016

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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