TY - JOUR
T1 - Investigating misdiagnosis of suspected cancer among patients undergoing pancreatoduodenectomy
T2 - three decades of experience
AU - Halle-Smith, James M.
AU - Bartlett, David
AU - Chatzizacharias, Nikolaos
AU - Dasari, Bobby VM.
AU - Marudanayagam, Ravi
AU - Sutcliffe, Robert P.
AU - Brown, Rachel M.
AU - Roberts, Keith J.
PY - 2024/3
Y1 - 2024/3
N2 - Background
Diagnostic error can result in pancreatoduodenectomy (PD) being mistakenly performed for benign disease. The aims of this study were to observe the error rate in PD over three decades and identify characteristics of benign disease that can mimic malignancy.
Methods
Patients with a benign histological diagnosis after having PD performed for suspected malignancy between 1988 and 2019 were selected for review. Preoperative clinical features, imaging and pathological samples were reviewed alongside resection specimens to identify features that may have led to misdiagnosis.
Results
Over the study period, 1812 patients underwent PD for suspected malignancy and 97 (5.2 %) of these had a final benign diagnosis. The rate of benign cases reduced across the study period. Some 62 patients proceeded to surgery without a preoperative tissue diagnosis; the decision to operate was made upon clinical and radiologic features alone. There were six patients who had a preoperative pathological sample suspicious for malignancy, of which two had autoimmune pancreatitis in the postoperative histology specimen.
Discussion
Benign conditions, notably autoimmune and chronic pancreatitis, can mimic malignancy even with the use of EUS-FNA. The results of all available diagnostic modalities should be interpreted by a multidisciplinary team and honest discussions with the patient should follow.
AB - Background
Diagnostic error can result in pancreatoduodenectomy (PD) being mistakenly performed for benign disease. The aims of this study were to observe the error rate in PD over three decades and identify characteristics of benign disease that can mimic malignancy.
Methods
Patients with a benign histological diagnosis after having PD performed for suspected malignancy between 1988 and 2019 were selected for review. Preoperative clinical features, imaging and pathological samples were reviewed alongside resection specimens to identify features that may have led to misdiagnosis.
Results
Over the study period, 1812 patients underwent PD for suspected malignancy and 97 (5.2 %) of these had a final benign diagnosis. The rate of benign cases reduced across the study period. Some 62 patients proceeded to surgery without a preoperative tissue diagnosis; the decision to operate was made upon clinical and radiologic features alone. There were six patients who had a preoperative pathological sample suspicious for malignancy, of which two had autoimmune pancreatitis in the postoperative histology specimen.
Discussion
Benign conditions, notably autoimmune and chronic pancreatitis, can mimic malignancy even with the use of EUS-FNA. The results of all available diagnostic modalities should be interpreted by a multidisciplinary team and honest discussions with the patient should follow.
U2 - 10.1016/j.hpb.2023.11.011
DO - 10.1016/j.hpb.2023.11.011
M3 - Article
SN - 1365-182X
VL - 26
SP - 344
EP - 351
JO - HPB : the official journal of the International Hepato Pancreato Biliary Association
JF - HPB : the official journal of the International Hepato Pancreato Biliary Association
IS - 3
ER -