Torbiele trzustki – Diagnostyka i diagnoza

Torbiele trzustki
Diagnostyka i diagnoza

Torbiele trzustki są często wykrywane przypadkowo podczas badań obrazowych, takich jak TK i MRI, z częstością sięgającą 10% u pacjentów poddawanych tym badaniom. Kluczowe jest rozróżnienie torbieli nowotworowych (np. IPMN, MCN) od nienowotworowych (np. pseudotorbiele), gdyż torbiele śluzowe mają potencjał złośliwości i wymagają często resekcji chirurgicznej. Diagnostyka opiera się na MRI/MRCP jako metodzie z wyboru, umożliwiającej ocenę komunikacji torbieli z przewodem trzustkowym oraz identyfikację cech ryzyka złośliwości, takich jak poszerzenie przewodu głównego ≥10 mm czy obecność komponentu litego. TK jest przydatna zwłaszcza w wykrywaniu zwapnień i u pacjentów, którzy nie mogą przejść MRI. Endoskopowa ultrasonografia (EUS) wraz z biopsją aspiracyjną cienkoigłową (EUS-FNA) pozwala na pobranie płynu do analizy cytologicznej i biochemicznej (m.in. CEA z wartością odcięcia 192 ng/ml, amylaza, CA 19-9), co wspomaga klasyfikację torbieli i ocenę ryzyka złośliwości. Nowoczesne metody, takie jak analiza molekularna płynu torbieli (NGS), endoskopowa mikroskopia konfokalna (CLE) oraz biopsja kleszczykowa pod kontrolą EUS (EUS-TTNB), zwiększają dokładność diagnostyczną do około 90%.

Diagnostyka torbieli trzustki

Torbiele trzustki są często diagnozowane przypadkowo podczas badań obrazowych jamy brzusznej wykonywanych z innych powodów. Zwiększona częstość wykrywania tych zmian w ostatnich latach wiąże się z powszechnym stosowaniem nowoczesnych technik obrazowania przekrojowego oraz ich rosnącą dokładnością¹². Badania sugerują, że torbiele trzustki mogą być widoczne nawet u 10% pacjentów poddawanych tomografii komputerowej (TK) lub rezonansowi magnetycznemu (MRI)³. Występowanie tych zmian wzrasta wraz z wiekiem pacjenta⁴.

Torbiele trzustki mogą być nowotworowe (np. wewnątrzprzewodowe brodawkowate nowotwory śluzowe – IPMN) lub nienowotworowe (np. pseudotorbiele). Prawidłowa klasyfikacja torbieli jest kluczowa, ponieważ torbiele nienowotworowe wymagają leczenia tylko w przypadku wystąpienia objawów, podczas gdy niektóre nowotworowe torbiele trzustki mają znaczny potencjał złośliwości i powinny być usunięte⁴¹.

Metody obrazowe w diagnostyce torbieli trzustki

Precyzyjna diagnostyka torbieli trzustki wymaga zastosowania różnych metod obrazowych. Wybór odpowiedniego badania zależy od konkretnej sytuacji klinicznej oraz dostępności technik diagnostycznych⁵.

Rezonans magnetyczny (MRCP)

MRI lub cholangiopankreatografia rezonansu magnetycznego (MRCP) są uznawane za badania z wyboru w diagnostyce i monitorowaniu torbieli trzustki⁶⁷. Metody te nie wykorzystują promieniowania jonizującego i zapewniają lepszą dokładność w ocenie komunikacji między głównym przewodem trzustkowym a torbielą (cecha charakterystyczna dla IPMN z bocznych odgałęzień)⁷. MRCP jest szczególnie pomocny w ocenie torbieli w przewodzie trzustkowym⁶.

MRI może uwidocznić subtelne szczegóły torbieli trzustki, w tym obecność komponentów wskazujących na zwiększone ryzyko złośliwości⁵. Badanie to wykazuje także zwiększoną czułość na płyny statyczne w sekwencjach T2-zależnych, co jest kluczowe dla właściwej oceny komunikacji z głównym przewodem trzustkowym⁸.

Tomografia komputerowa (TK)

Tomografia komputerowa jest często pierwszym badaniem wykrywającym torbiele trzustki¹. TK może dostarczyć szczegółowych informacji na temat wielkości i struktury torbieli trzustki⁵. Jest to najbardziej powszechnie wykonywane badanie obrazowe w diagnostyce patologii jamy brzusznej w warunkach oddziału ratunkowego i szpitalnych, dlatego większość torbieli trzustki jest wykrywana podczas badań TK wykonywanych z powodów niezwiązanych z trzustką⁹¹⁰.

TK jest szczególnie skuteczna w wykrywaniu zwapnień w obrębie torbieli, co stanowi pomocną cechę w diagnostyce różnicowej⁸. U pacjentów w podeszłym wieku lub niewspółpracujących TK z rekonstrukcją wielopłaszczyznową zakrzywioną (MPR) jest wartościową techniką do oceny komunikacji z głównym przewodem trzustkowym⁸.

Endoskopowa ultrasonografia (EUS)

Endoskopowa ultrasonografia jest uznawana za złoty standard w obrazowaniu trzustki⁹. Badanie to, podobnie jak MRI, może dostarczyć szczegółowego obrazu torbieli⁵. EUS umożliwia pobranie płynu z torbieli do analizy w kierunku potencjalnych cech złośliwości⁵.

EUS jest szczególnie przydatna w ocenie torbieli, które pozostają niejednoznaczne w innych badaniach obrazowych lub mają cechy budzące niepokój. Umożliwia dokładną wizualizację ściany torbieli, granic, przegród, mas, guzków przyściennych, projekcji brodawkowatych oraz komunikacji z głównym przewodem trzustkowym¹¹. Jednak dokładność diagnostyczna morfologii EUS w różnicowaniu torbieli śluzowych od nieśluzowych jest zależna od operatora, a nawet doświadczeni endosonografiści mają umiarkowaną zgodność w różnicowaniu zmian nowotworowych od nienowotworowych⁹.

Podsumowując, zarówno MRI z MRCP, jak i TK mają wysoką skuteczność diagnostyczną w różnicowaniu łagodnych i złośliwych torbieli trzustki, przy czym dokładność waha się od 73% do 81% dla MRI i od 75% do 78% dla TK⁸.

Biopsja cienkoigłowa pod kontrolą EUS (EUS-FNA)

EUS-FNA (biopsja aspiracyjna cienkoigłowa pod kontrolą endoskopowej ultrasonografii) jest często wymagana do klasyfikacji torbieli trzustki jako śluzowych lub nieśluzowych oraz do oceny ich potencjału złośliwości¹⁰¹². Ta metoda pozwala na pobranie płynu torbieli do analizy cytologicznej i biochemicznej¹³.

Biopsja EUS-FNA jest wskazana w torbielach, w których diagnoza jest niejasna, a wyniki mogą wpłynąć na dalsze postępowanie⁷. Procedura ta jest stosunkowo bezpieczna, z niskim ryzykiem powikłań wynoszącym 0,1%, choć jest względnie przeciwwskazana u pacjentów z wysokim ryzykiem krwawienia (INR > 1,2, płytki krwi 10 mm¹⁴.

Analiza płynu z torbieli

Analiza płynu pobranego z torbieli jest kluczowym elementem diagnostyki różnicowej torbieli trzustki¹⁵¹⁶. Badania mogą obejmować:

Analizę cytologiczną – ocena komórek pod kątem obecności komórek dysplastycznych lub nowotworowych¹⁷
Markery biochemiczne:
- CEA (antygen karcinoembrionalny) – CEA w płynie torbieli wykazuje dobrą dokładność (86%) i przyzwoitą czułość (81%) w różnicowaniu torbieli śluzowych od nieśluzowych przy wartości odcięcia 192 ng/ml, jednak nie jest w stanie wiarygodnie różnicować między zmianami złośliwymi i łagodnymi⁹. Badanie z 2012 roku wykazało, że czułość dla CEA wynosiła 91,8% w przypadku zmian śluzowych¹⁸
- Amylaza – zawartość amylazy w pseudotorbielach jest prawie zawsze wysoka, podczas gdy poziom w torbielach nowotworowych jest zazwyczaj niski¹⁶
- CA 19-9 – badanie z 2012 r. wykazało, że czułość dla CA 19-9 wynosiła 81,3% dla zmian śluzowych¹⁸
- Glukoza – może pomóc w rozróżnieniu torbieli śluzowych od nieśluzowych¹⁹

W ostatnich latach rozwija się również badanie markerów molekularnych w płynie torbieli. Analiza DNA może identyfikować zmutowane geny uwalniane do płynu torbieli po śmierci komórek²⁰. Badania pokazują, że analiza molekularna może poprawić klasyfikację torbieli trzustki jako śluzowych lub nieśluzowych, co jest istotne, ponieważ torbiele śluzowe są zmianami przedrakowymi i mają wyższe ryzyko współistnienia gruczolakoraka trzustki²¹.

Nowe techniki diagnostyczne

W diagnostyce torbieli trzustki pojawiają się nowe, obiecujące metody, które mogą zwiększyć dokładność diagnostyczną²²:

Molekularna analiza płynu torbieli wykorzystująca sekwencjonowanie nowej generacji (NGS)²²
Endoskopowa mikroskopia konfokalna (CLE) – technika umożliwiająca mikroskopową ocenę tkanek w czasie rzeczywistym podczas endoskopii²³
Biopsja kleszczykowa przez igłę pod kontrolą EUS (EUS-TTNB) – pozwala na pobranie większej próbki tkanki do badania histopatologicznego¹¹

Dokładność tych nowych metod w identyfikacji torbieli śluzowych w porównaniu do nieśluzowych wynosi około 90%²⁴. W badaniu prospektywnym z Uniwersytetu w Pittsburghu obejmującym 102 pacjentów, którzy przeszli resekcję chirurgiczną, analiza molekularna wykazała czułość 89% i swoistość 100% w rozróżnianiu rodzajów torbieli²⁴.

Klasyfikacja torbieli trzustki

Właściwa klasyfikacja torbieli trzustki jest kluczowa dla określenia ryzyka złośliwości oraz wyboru optymalnego postępowania. Torbiele można podzielić na dwie główne kategorie: nowotworowe (neoplastyczne) i nienowotworowe (nieneoplastyczne)⁴.

Torbiele nowotworowe

Nowotworowe torbiele trzustki mogą być śluzowe lub nieśluzowe. Torbiele śluzowe są uważane za zmiany przedrakowe z potencjałem złośliwości¹.

Torbiele śluzowe

Wewnątrzprzewodowe brodawkowate nowotwory śluzowe (IPMN) – cysty, które rozwijają się w przewodach trzustki²⁵. Mogą dotyczyć głównego przewodu trzustkowego (MD-IPMN), bocznych odgałęzień (BD-IPMN) lub obu (mieszany typ IPMN). IPMN głównego przewodu mają wyższe ryzyko złośliwości – średnia częstość występowania zmian złośliwych wynosi 61,6%, a średnia częstość inwazyjnego IPMN to 43,1%²⁶.
Śluzowe torbielowate nowotwory (MCN) – występują głównie u kobiet, zwykle w trzonie lub ogonie trzustki. MCN charakteryzują się obecnością typowego podścieliska podobnego do jajnikowego²⁷. Średnia częstość złośliwości w usuniętych MCN wynosi 25,5%, a średnia częstość inwazyjnego raka to 17,7%²⁶.

Torbiele nieśluzowe

Surowicze torbielakogruczolaki (SCA) – zazwyczaj łagodne torbiele, które bardzo rzadko ulegają transformacji złośliwej²⁵.
Lite pseudobrodawkowate nowotwory (SPN) – rzadkie guzy, które mogą mieć komponenty torbielowate. Występują głównie u młodych kobiet i mają potencjał złośliwości²⁵.
Torbielowate nowotwory neuroendokrynne – rzadkie zmiany, które mogą być trudne do odróżnienia od innych torbieli trzustki²⁸.

Torbiele nienowotworowe

Najczęstszym typem nienowotworowej torbieli trzustki jest pseudotorbiel, która zwykle powstaje w wyniku ostrego lub przewlekłego zapalenia trzustki²⁹. Pseudotorbiele nie mają nabłonkowej wyściółki i są wypełnione płynem bogatym w enzymy trzustkowe³⁰.

Ocena ryzyka złośliwości torbieli trzustki

Kluczowym aspektem diagnostyki torbieli trzustki jest określenie ich potencjału złośliwości¹. Ryzyko transformacji złośliwej zależy od rodzaju i histologii torbieli, jej wielkości, obecności elementów litych, lokalizacji oraz wieku pacjenta¹¹⁰.

Cechy wysokiego ryzyka

Wytyczne międzynarodowe definiują cechy wysokiego ryzyka (high-risk stigmata) oraz cechy budzące niepokój (worrisome features), które pomagają w stratyfikacji ryzyka i podejmowaniu decyzji terapeutycznych³¹³².

Cechy wysokiego ryzyka obejmują:

Żółtaczkę obturacyjną spowodowaną torbielą w głowie trzustki³³³²
Komponent lity wzmacniający się po podaniu kontrastu³³
Poszerzenie głównego przewodu trzustkowego ≥10 mm bez innej przyczyny niedrożności²⁸
Obecność komórek z dużego stopnia dysplazji lub komórek nowotworowych w cytologii³²

Cechy budzące niepokój

Cechy budzące niepokój obejmują:

Wielkość torbieli ≥3 cm³¹³⁴
Pogrubiałą/wzmocnioną ścianę torbieli²⁸
Guzek przyścienny ≥5 mm²⁰⁹
Poszerzenie głównego przewodu trzustkowego 5-9 mm²⁸
Szybki wzrost torbieli (≥5 mm/2 lata)²⁸
Obecność niepwzmocnionych guzków przyściennych²⁸

Obecność tych cech w badaniach obrazowych powinna być wskazaniem do wykonania EUS-FNA w celu oceny cytologicznej i analizy płynu⁹¹⁰.

Czynniki kliniczne ryzyka

Oprócz cech radiologicznych, istnieją również kliniczne czynniki ryzyka zwiększające prawdopodobieństwo złośliwości torbieli:

Nowo rozpoznana lub pogarszająca się cukrzyca³²³⁵
Nawracające ostre zapalenie trzustki³²
Podwyższony poziom CA 19-9 w surowicy³²³⁶
Szybki wzrost rozmiaru torbieli (≥3 mm/rok)³⁵

Pacjenci z IPMN lub MCN, u których występuje nowo rozpoznana lub pogarszająca się cukrzyca, szybki wzrost torbieli (≥3 mm/rok) podczas nadzoru, mogą mieć zwiększone ryzyko złośliwości i powinni przejść badanie MRI lub EUS-FNA w krótkim odstępie czasu³⁵.

Strategie postępowania z torbielami trzustki

Postępowanie z torbielami trzustki powinno być zindywidualizowane i opierać się na oszacowanym ryzyku złośliwości, obecności objawów oraz preferencjach pacjenta³⁷.

Nadzór i monitorowanie

Pacjenci z torbielami bezobjawowymi, które są diagnozowane jako pseudotorbiele na podstawie początkowego obrazowania i wywiadu klinicznego, lub mają bardzo niskie ryzyko transformacji złośliwej (takie jak SCA), nie wymagają leczenia ani dalszej oceny³⁵.

Nadzór torbieli powinien być oferowany pacjentom, którzy kwalifikują się do operacji, z bezobjawowymi torbielami, które przypuszczalnie są IPMN lub MCN³⁵. Schemat nadzoru zależy od wielkości torbieli i obecności cech ryzyka³⁸:

Torbiele mniejsze niż 1 cm: badanie obrazowe co 2 lata przez 4 lata³⁸
Torbiele 1-2 cm: rozważyć dodanie EUS do oceny²²
Torbiele większe niż 2 cm: ocena za pomocą EUS²²
Torbiele większe niż 3 cm: skierowanie do wielodyscyplinarnego zespołu³⁸

Według wytycznych American Gastroenterological Association (AGA), pacjenci z torbielami trzustki <3 cm bez komponentu litego lub poszerzonego przewodu trzustkowego powinni przejść badanie MRI po roku, a następnie co 2 lata przez łącznie 5 lat, jeśli nie ma zmian w wielkości lub charakterystyce³¹.

Europejskie wytyczne (2018) zalecają nadzór w przypadku bezobjawowego MCN <40 mm bez wzmacniającego się po kontraście guzka przyściennego w MRI³⁹.

Wskazania do leczenia chirurgicznego

Torbiele trzustki z cechami wysokiego ryzyka oraz te z znanym wysokim ryzykiem złośliwości, takie jak IPMN głównego przewodu i lite guzy pseudobrodawkowate, powinny być kierowane do resekcji chirurgicznej⁴⁰.

AGA sugeruje, że pacjenci z zarówno komponentem litym, jak i poszerzonym przewodem trzustkowym i/lub niepokojącymi cechami w EUS i FNA powinni przejść operację w celu zmniejszenia ryzyka śmiertelności z powodu raka³³.

AGA zaleca, aby pacjenci rozważający operację z powodu torbieli trzustki byli kierowani do ośrodka z udokumentowanym doświadczeniem w chirurgii trzustki⁴¹.

Zgodnie z wytycznymi międzynarodowymi, obecność worrisome features lub high-risk features, cytologia sugerująca lub pozytywna w kierunku złośliwości, poszerzenie głównego przewodu trzustkowego ≥10 mm (bez oznak wtórnej niedrożności lub przewlekłego zapalenia trzustki) lub wysokie podejrzenie MD-IPMN lub mieszanego typu IPMN są wskazaniami do resekcji chirurgicznej⁴².

Nadzór po leczeniu chirurgicznym

AGA sugeruje, że pacjenci z inwazyjnym rakiem lub dysplazją w torbieli, która została chirurgicznie usunięta, powinni przejść nadzór MRI pozostałej trzustki co 2 lata⁴¹.

AGA sugeruje przeciwko rutynowemu nadzorowi torbieli trzustki bez dysplazji wysokiego stopnia lub złośliwości po resekcji chirurgicznej⁴¹.

Pacjenci, którzy przeszli resekcję i zostali zdiagnozowani z torbielowatym nowotworem śluzowym (MCN) nie wymagają nadzoru³⁸. Natomiast osoby z dysplazją niskiego lub umiarkowanego stopnia powinny przejść badanie fizykalne i MRI lub EUS co sześć miesięcy³⁸.

Wytyczne i algorytmy diagnostyczne

Istnieje kilka zestawów wytycznych dotyczących diagnostyki i postępowania z torbielami trzustki, opracowanych przez różne towarzystwa naukowe¹⁴. Główne wytyczne zostały wydane przez:

American Gastroenterological Association (AGA)³¹
American College of Gastroenterology (ACG)⁴³
International Association of Pancreatology (IAP)/wytyczne Fukuoka³⁹
European Study Group on Cystic Tumors of the Pancreas³⁹
American College of Radiology (ACR)¹⁴

Wytyczne te różnią się w niektórych aspektach, ale ich głównym celem jest zapobieganie złośliwości i łagodzenie objawów; zalecenia dotyczące nadzoru i resekcji chirurgicznej są oparte na objawach i postrzeganym ryzyku złośliwości⁴⁴.

Algorytm diagnostyczny

Ogólny algorytm diagnostyczny dla torbieli trzustki można podsumować następująco:

Wykrycie torbieli w badaniu obrazowym (najczęściej przypadkowe podczas badań wykonywanych z innych wskazań)²⁹
Ocena kliniczna, wywiad i badanie fizykalne:
- Wywiad w kierunku ostrego lub przewlekłego zapalenia trzustki³⁹
- Wywiad rodzinny w kierunku raka trzustki lub dziedzicznych zespołów związanych ze zwiększonym ryzykiem raka trzustki⁴⁵
Badanie obrazowe dedykowane dla trzustki:
- MRI/MRCP jako badanie z wyboru dla nowo zdiagnozowanych torbieli⁴⁴
- TK trzustki jako alternatywa, szczególnie dla pacjentów, którzy nie mogą przejść MRI⁷
Ocena cech wysokiego ryzyka i cech budzących niepokój²⁸
W przypadku obecności tych cech lub gdy diagnoza pozostaje niejednoznaczna:
- EUS z aspiracją cienkoigłową (FNA) do cytologii i analizy płynu⁷
- Analiza biochemiczna płynu (CEA, amylaza)¹⁶
- W niektórych ośrodkach analiza molekularna płynu torbieli⁴⁶
Klasyfikacja torbieli i ocena ryzyka złośliwości¹⁵
Decyzja o dalszym postępowaniu (nadzór, resekcja chirurgiczna)³⁷

Multidyscyplinarne podejście

Diagnostyka i leczenie pacjentów z torbielami trzustki najlepiej przeprowadzać poprzez podejście multidyscyplinarne⁴⁷. Zespół specjalistów obejmujący chirurgów, radiologów i gastroenterologów współpracuje w celu potwierdzenia diagnozy i opracowania optymalnego planu leczenia⁴⁷.

W niektórych ośrodkach przypadki pacjentów są omawiane na wielodyscyplinarnych spotkaniach poświęconych torbielom trzustki, w których uczestniczą gastroenterolodzy, chirurdzy, patolodzy i radiolodzy⁴⁸. Takie podejście zapewnia kompleksową ocenę ryzyka i korzyści z potencjalnych interwencji chirurgicznych⁴⁹.

Ograniczenia w diagnostyce torbieli trzustki

Pomimo postępów w diagnostyce, torbiele trzustki nadal stanowią wyzwanie diagnostyczne. Obecne metody mają pewne ograniczenia⁵⁰:

Dokładność MRI lub MRCP w diagnozowaniu typu torbieli wynosi 40-50%, a w określaniu charakteru łagodnego vs złośliwego 55-76%. Dokładność dla TK i EUS bez FNA jest podobna⁴³.
Cytologia płynu torbieli ma niską wydajność diagnostyczną, z czułością poniżej 50% dla zmian śluzowych, chociaż jest pomocna, gdy jest pozytywna dla określonej diagnozy³⁷.
Ogólna dokładność diagnostyczna morfologii EUS w różnicowaniu torbieli śluzowych od nieśluzowych waha się od 48% do 94%, z czułością od 36% do 91% i swoistością od 45% do 81%¹⁴.
Mimo zastosowania zaawansowanych technik obrazowania, endoskopowych, cytopatologicznych i analizy biomarkerów, precyzyjne określenie, które torbiele trzustki zawierają zmiany złośliwe lub są zagrożone progresją, pozostaje wyzwaniem⁵¹.

Przyszłe kierunki w diagnostyce torbieli trzustki

Badania nad nowymi metodami diagnostycznymi torbieli trzustki koncentrują się na:

Rozwoju biomarkerów molekularnych do dokładniejszego określania rodzaju torbieli i potencjału złośliwości⁵²
Udoskonaleniu technik endoskopowych, takich jak konfokalna laserowa endomikroskopia (CLE) i biopsja mikrokleszczykowa¹³
Zastosowaniu sztucznej inteligencji (AI) i analizy tekstury obrazu do lepszej stratyfikacji IPMN⁵³
Opracowaniu nowych algorytmów diagnostycznych integrujących dane kliniczne, radiologiczne i molekularne⁵⁴

Kluczowe znaczenie będą miały dalsze badania nad naturalną historią zmian torbielowatych, w tym ostateczne określenie tempa transformacji złośliwej dla każdego typu torbieli².

Podsumowanie

Diagnostyka torbieli trzustki wymaga kompleksowego podejścia łączącego dane kliniczne, wyniki badań obrazowych i analizę płynu torbieli. Dokładna identyfikacja rodzaju torbieli jest kluczowa dla określenia ryzyka złośliwości i wyboru optymalnego postępowania.

MRI/MRCP są obecnie metodami z wyboru w diagnostyce i monitorowaniu torbieli trzustki, podczas gdy EUS-FNA dostarcza cennych informacji cytologicznych i biochemicznych w przypadkach niepewnych lub z cechami wysokiego ryzyka.

Postępowanie z torbielami trzustki powinno być zindywidualizowane, z uwzględnieniem typu torbieli, obecności cech ryzyka oraz ogólnego stanu klinicznego pacjenta. Podejście multidyscyplinarne, z udziałem gastroenterologów, radiologów, patologów i chirurgów, zapewnia optymalne zarządzanie tymi często skomplikowanymi przypadkami.

Ciągły rozwój nowych metod diagnostycznych, w tym analizy molekularnej i zaawansowanych technik endoskopowych, obiecuje dalszą poprawę dokładności diagnostycznej i stratyfikacji ryzyka w przyszłości.

Kolejne rozdziały

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Materiały źródłowe

#1 Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC9914101/
The prevalence of pancreatic cysts has been rising due to the widespread use of cross-sectional imaging (CT scan and MRI) of the abdomen. […] A critical question following the detection of a PC is whether to treat, continue surveillance, or reassure the patient that it is benign. […] Broadly, mucinous cysts are neoplastic and have higher malignant potential, and the first step of risk stratification has to focus on differentiating mucinous from non-mucinous cysts. […] The risk of malignant transformation depends on the type and histology, the size of the lesion, the presence of solid components, the distribution of PC, and the age of the patient. […] A CT scan is the most widely obtained imaging modality for the evaluation of abdominal pathology in the emergency department and inpatient setting, and thus, the majority of PCs are discovered on abdominal CT performed for unrelated reasons.
#2 Diagnosis and Management of Pancreatic Cysts – PubMed
https://pubmed.ncbi.nlm.nih.gov/38442782/
As pancreatic cyst incidence rises, likely due to the ubiquitous increase in cross-sectional imaging, their management presents multiple challenges for both the practitioner and patient. It is critical that all pancreatic cysts are appropriately characterized, as treatment decisions depend on an accurate diagnosis. Diagnostic modalities such as cytology, biopsy, and cyst fluid biomarkers allow for definitive diagnosis of virtually all lesions. […] Cysts with high-risk stigmata or worrisome features are usually resected, depending on the patient’s surgical fitness. In patients unfit for resection, newer endoscopic ablative techniques are advocated. […] Further study into the natural history of cystic lesions, including definitive determination of the rate of malignant transformation for each cyst type, is essential.
#3 Pancreatic Cyst: Symptoms, Causes, Types & Treatment
https://my.clevelandclinic.org/health/diseases/pancreatic-cyst
Studies suggest that approximately 10% of CT scans (computed tomography scans) and MRIs (magnetic resonance imaging) discover pancreatic cysts. […] Less than 1% of pancreatic cysts turn into cancer. But up to 30% of pancreatic cysts have the potential to turn into cancer. This is why healthcare providers keep an eye on them. […] Healthcare providers diagnose a pancreatic cyst using: Radiology: High-quality imaging, like a CT or MRI scan, can detect pancreatic cysts. […] A procedure called endoscopic ultrasound allows a provider to access a pancreatic cyst through a tiny endoscope, guided by a tiny ultrasound wand. […] Healthcare providers analyze the content of the cystic fluid in a lab to determine the type. […] Most cysts are treated with surveillance. […] Some types of benign cysts may shrink or even disappear on their own, but neoplastic types dont.
#4 Classification of pancreatic cysts – UpToDate
https://www.uptodate.com/contents/classification-of-pancreatic-cysts
Pancreatic cysts are diagnosed with increasing frequency because of the widespread use of cross-sectional imaging. Pancreatic cysts may be detected in 40 to 50 percent of patients who undergo abdominal magnetic resonance imaging for unrelated reasons. The frequency increases with age. […] Pancreatic cysts can either be neoplastic (eg, intraductal papillary mucinous neoplasms) or non-neoplastic. Accurate cyst categorization is important, since non-neoplastic cysts require treatment only if symptomatic, whereas some of the pancreatic cystic neoplasms have significant malignant potential and should be resected. […] This topic will review the classification of pancreatic cysts. An overview of pancreatic cystic neoplasms and issues related to pancreatic inflammatory fluid collections and intraductal papillary mucinous neoplasms of the pancreas are discussed separately.
#5 Pancreatic cysts – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/pancreatic-cysts/diagnosis-treatment/drc-20375997
Pancreatic cysts are diagnosed more often than in the past because improved imaging technology finds them more readily. Many pancreatic cysts are found during abdominal scans for other problems. […] After taking a medical history and performing a physical exam, your doctor may recommend imaging tests to help with diagnosis and treatment planning. Tests include: […] Computerized tomography (CT) scan. This imaging test can provide detailed information about the size and structure of a pancreatic cyst. […] MRI scan. This imaging test can highlight subtle details of a pancreatic cyst, including whether it has any components that suggest a higher risk of cancer. […] Endoscopic ultrasound. This test, like an MRI, can provide a detailed image of the cyst. Also, fluid can be collected from the cyst for analysis in a laboratory for possible signs of cancer.
#6 Pancreatic cysts – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/pancreatic-cysts/diagnosis-treatment/drc-20375997
Magnetic resonance cholangiopancreatography (MRCP). magnetic resonance cholangiopancreatography (MRCP) is considered the imaging test of choice for monitoring a pancreatic cyst. This type of imaging is especially helpful for evaluating cysts in the pancreatic duct. […] The characteristics and location of the pancreatic cyst, along with your age and sex, can sometimes help doctors determine the type of cyst you have. […] What tests do I need? […] What type of cyst do I have? […] Is it likely to become cancerous?
#7
https://journals.lww.com/ajg/fulltext/2018/04000/acg_clinical_guideline__diagnosis_and_management.8.aspx
MRI or magnetic resonance cholangiopancreatography (MRCP) are the tests of choice because of their non-invasiveness, lack of radiation, and greater accuracy in assessing communication between the main pancreatic duct and the cyst (which is a characteristic of side-branch IPMNs). Pancreatic protocol CT or EUS are excellent alternatives in patients who are unable to undergo MRI. Indeterminate cysts may benefit from a second imaging modality or cyst fluid analysis via EUS. […] EUS-FNA and cyst fluid analysis should be considered in cysts in which the diagnosis is unclear, and where the results are likely to alter management. Analysis of cyst fluid CEA may be considered to differentiate IPMNs and MCNs from other cyst types, but cannot be used to identify IPMNs and MCNs with high-grade dysplasia or pancreatic cancer.
#8 Cystic pancreatic lesions: MR imaging findings and management | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01060-z
Differential diagnosis among different CPLs is also emphasized. […] MRI with MRCP, thanks to its high contrast resolution and high sensitivity to static fluids on T 2 w sequences, is the best imaging technique to assess communication with MPD (which is the key factor to characterize a CPL); on the other hand, MDCT is the best imaging technique to demonstrate the presence, the intra-lesional localization and the size of eventual calcifications, helpful findings in the differential diagnosis; moreover, in elderly and uncooperative patients MDCT with curved multiplanar reconstruction (MPR) post-processing is a valid technique to assess communication with MPD. […] Both MRI with MRCP and MDCT have high diagnostic performance in differentiating benign from malignant CPLs, with an accuracy ranging from 73 to 81% for MRI and 75% to 78% for MDCT, respectively.
#9 Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC9914101/
EUS is considered the gold standard for pancreatic imaging. […] The overall diagnostic accuracy of EUS morphology at differentiating mucinous from non-mucinous cysts is operator dependent, and even the experienced endosonographers have a modest agreement at differentiating neoplastic from non-neoplastic cysts. […] The presence of these features on cross-sectional imaging should prompt EUS-FNA for cytology and fluid analysis. […] The mural nodule has been shown to be an independent predictor of malignancy (invasive carcinoma or high-grade dysplasia) in IPMN. […] Morphologic features on EUS cannot reliably characterize PC. […] Cyst fluid CEA has been shown to have good accuracy (86%) and decent sensitivity (81%) at differentiating mucinous from non-mucinous cysts using a cutoff of 192 ng/mL; however, it is unable to discriminate between malignant and benign cysts reliably.
#10 Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature
https://www.mdpi.com/2075-4418/13/3/550
A CT scan is the most widely obtained imaging modality for the evaluation of abdominal pathology in the emergency department and inpatient setting, and thus, the majority of PCs are discovered on abdominal CT performed for unrelated reasons. […] MRI with MRCP can demonstrate the communication of the cyst with MPD. […] The overall diagnostic accuracy of EUS morphology at differentiating mucinous from non-mucinous cysts is operator dependent, and even the experienced endosonographers have a modest agreement at differentiating neoplastic from non-neoplastic cysts. […] The presence of these features on cross-sectional imaging should prompt EUS-FNA for cytology and fluid analysis. […] The risk of malignant transformation depends on the type and histology, the size of the lesion, the presence of solid components, the distribution of PC, and the age of the patient.
#10 Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature
https://www.mdpi.com/2075-4418/13/3/550
The prevalence of pancreatic cysts has been rising due to the widespread use of cross-sectional imaging (CT scan and MRI) of the abdomen. […] A critical question following the detection of a PC is whether to treat, continue surveillance, or reassure the patient that it is benign. […] The risk stratification of these lesions is not straightforward, and individual risk assessment, cyst size, distribution, and alarming morphologic features (when present) can guide the next steps in management. […] Endoscopic ultrasound with fine-needle aspiration is often required to classify pancreatic cysts into mucinous and non-mucinous cysts and to assess the malignant potential. […] Advances in endoscopic techniques (confocal laser endomicroscopy, microforceps biopsy) can provide a definitive diagnosis of pancreatic cysts in some cases; however, the use of these techniques involves a higher risk of adverse events.
#11
https://link.springer.com/article/10.1007/s10620-021-07084-1
It is important to characterize these PCLs with high-quality imaging studies to assess for clues of HGD and invasive carcinoma and to determine the type of cyst the patient has in order to guide management. […] MRI and magnetic resonance cholangiopancreatography (MRCP) are typically preferred over computed tomography (CT) due to lack of radiation and its superior ability to diagnose IPMNs and identify high-risk features. […] Since MRI, MRCP, and CT have less than 50% accuracy for diagnosing the specific type of cyst in a patient, endoscopic ultrasound (EUS) has emerged as a secondary diagnostic modality to evaluate cysts further. […] EUS imaging provides visualization of wall thickness, borders, septations, masses, mural nodules, papillary projections, and communication with the main pancreatic duct.
#11
https://link.springer.com/article/10.1007/s10620-021-07084-1
EUS has ushered in a plethora of opportunities for diagnostic testing of cyst fluid via cytology, pathology, molecular, and chemical analyses. […] Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) enables endosonographers to analyze cyst fluid in order to further characterize the PCL in question. […] Cyst fluid cytology detects malignancy with high specificity (91%) but similar to many other cyst fluid markers has low sensitivity (65%). […] Advances in molecular fluid analysis with DNA-based markers have gained considerable interest as a tool to differentiate mucinous from nonmucinous lesions, characterize mucinous subtypes (IPMN versus MCN), and detect grades of neoplasia. […] Given the diagnostic limitations of cytology and cyst fluid analysis, interest has blossomed for EUS-guided through-the-needle biopsy (TTNB), which offers the possibility of the holy grail of pathology.
#12 Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature
https://scholarworks.indianapolis.iu.edu/items/7cce1491-a0a2-4d8f-90b5-118bfa31543e
The prevalence of pancreatic cysts has been rising due to the widespread use of cross-sectional imaging (CT scan and MRI) of the abdomen. […] While most pancreatic cysts are benign and do not require treatment or surveillance, a significant minority are premalignant and rarely malignant. […] The risk stratification of these lesions is not straightforward, and individual risk assessment, cyst size, distribution, and alarming morphologic features (when present) can guide the next steps in management. […] Neoplastic pancreatic cysts are mucinous or non-mucinous. […] Endoscopic ultrasound with fine-needle aspiration is often required to classify pancreatic cysts into mucinous and non-mucinous cysts and to assess the malignant potential. […] Advances in endoscopic techniques (confocal laser endomicroscopy, microforceps biopsy) can provide a definitive diagnosis of pancreatic cysts in some cases; however, the use of these techniques involves a higher risk of adverse events.
#13 Diagnostics and Management of Pancreatic Cystic LesionsâNew Techniques and Guidelines
https://www.mdpi.com/2077-0383/13/16/4644
Pancreatic cystic lesions (PCLs) are increasingly diagnosed owing to the wide use of cross-sectional imaging techniques. Accurate identification of PCL categories is critical for determining the indications for surgical intervention or surveillance. The classification and management of PCLs rely on a comprehensive and interdisciplinary evaluation, integrating clinical data, imaging findings, and cyst fluid markers. EUS (endoscopic ultrasound) has become the widely used diagnostic tool for the differentiation of pancreatic cystic lesions, offering detailed evaluation of even small pancreatic lesions with high sensitivity and specificity. […] EUS-guided fine-needle aspiration (FNA), EUS-guided fine-needle-based confocal laser endomicroscopy (nCLE), and needle microforceps biopsy are promising techniques for differentiating between mucinous and non-mucinous cysts. These advanced techniques offer significant advantages over traditional methods, enhancing diagnostic accuracy and aiding in therapeutic decisions.
#14 Diagnostics and Management of Pancreatic Cystic LesionsâNew Techniques and Guidelines
https://www.mdpi.com/2077-0383/13/16/4644
A recent meta-analysis showed that cyst fluid cytology had a sensitivity of 42% and a specificity of 99% for differentiating mucinous from non-mucinous pancreatic cystic neoplasms (PCNs). […] EUS morphology alone has an accuracy ranging from 48% to 94% in distinguishing between mucinous and non-mucinous PCNs, with sensitivity (the true positive rate) ranging from 36% to 91% and specificity (the true negative rate) ranging from 45% to 81%. […] EUS-FNA is generally safe, with a low complication risk of 0.1%, though it is relatively contraindicated in patients with a high risk of bleeding (INR > 1.2, platelets < 100,000, or the use of dual antiplatelet therapy) or a distance between the cyst and the transducer >10 mm. […] The management of pancreatic cystic lesions (PCLs) is guided by five principal sets of recommendations: the guidelines issued by the American Gastrointestinal Association (AGA), the American College of Gastroenterology (ACG), the American College of Radiology (ACR), UEG, and the International Association of Pancreatology (IAP)/Fukuoka guidelines.
#15 Pancreatic cystic lesions. Differential diagnosis and treatment strategy | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-pancreatic-cystic-lesions-differential-diagnosis-articulo-S2255534X22000305
The aim of the present review is to provide a diagnostic path that facilitates the characterization and adequate treatment of IPCLs. […] Accurate diagnosis enables the selection of patients that will truly benefit from surgical treatment. […] Specific morphologic, imaging, cytologic, and biochemical characteristics modify treatment strategy; their presence aids in assessing the risk for malignant transformation (worrisome features) or the presence of malignancy at the time of evaluation (high-risk features). […] Imaging methods are essential in the evaluation of IPCLs. Location, number, size, main pancreatic duct dilation or branch ducts communicating with the main pancreatic duct, the presence of septations, locules, nodules, or wall thickening are morphologic features that are key to making a presumptive diagnosis which eventually must be supported by the physicochemical characteristics of the fluid (e.g., viscosity and amylase, glucose, and CEA levels).
#16 Pancreatic cyst fluid analysis for differential diagnosis between benign and malignant lesions
https://www.spandidos-publications.com/10.3892/ol.2012.1071
The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. […] The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 199) and amylase analysis in pancreatic cyst fluid. […] Analysis of cystic fluid may be useful for distinguishing between benign and malignant pancreatic lesions. […] CEA has the highest diagnostic accuracy for discriminating premalignant mucinous from nonmucinous cysts. […] CA 19-9 cyst fluid analysis may also be useful for differential diagnosis of pancreatic cysts, particularly in pancreatic cystadenocarcinoma detection. […] The amylase content of pseudocysts is almost always high, whereas the level in neoplastic cysts is generally low.
#17 Pancreatic Cyst Diagnosis | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/pancreatic-cysts/diagnosis
A biopsy is a procedure to take a tissue sample from the pancreas. Most biopsies are done during an endoscopic ultrasound (EUS). […] A doctor called a pathologist will examine the pancreatic cyst tissue and fluid under a microscope. The pathologist will find what type of cells are in the sample, and if any are cancer cells. […] MSK pathologists are experts in diagnosing pancreatic cysts. Because of their experience, theyâre often asked to review biopsy samples from labs other than MSK. […] Most pancreatic cysts are benign (not cancer) and have a low chance of harming you. MSK’s team of pancreatic cysts experts will review your test results. Together they will make a plan for you based on whether the pancreatic cyst needs treatment.
#18 Pancreatic cyst fluid analysis for differential diagnosis between benign and malignant lesions
https://www.spandidos-publications.com/10.3892/ol.2012.1071
The aim of the present study was to assess the diagnostic utility and clinical value of CEA, CA 19-9 and amylase analysis in pancreatic cyst fluid. […] The present study identified that the median cyst fluid CEA and CA 19-9 levels in premalignant/malignant cysts was significantly higher than in benign cysts. […] Sensitivity for CEA and CA 19-9 was 91.8 and 81.3%, respectively, for mucinous lesions. […] The combination of CEA fluid assessment and K-ras mutation analysis levels was confirmed to maximize the diagnostic yield of pancreatic cyst biopsy and improve sensitivity and specificity of cyst classification. […] The present study indicates that analysis of pancreatic cyst fluid may be a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions.
#19 Updates in diagnosis and management of pancreatic cysts
https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm
Updates in diagnosis and management of pancreatic cysts. […] Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. […] Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. […] EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. […] Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. […] This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery.
#20 Guidelines for the Diagnosis and Management of Pancreatic Cystic Neoplasms – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/guidelines-for-the-diagnosis-and-management-of-pancreatic-cystic-neoplasms/
DNA testing of pancreatic cyst fluid can identify mutated genes released into the pancreatic cyst fluid following cell death. […] The presence of an enhancing mural nodule 5 mm has been used as a positive predictor of advanced pancreatic neoplasia in IPMN; however, the investigators suggest a more reliable cut-off size should be obtained using standardized methodology. […] Dilation of the main pancreatic duct is highly predictive for advanced pancreatic neoplasia in IPMN.
#21 Pancreatic Cancer Risk Testing Using Pancreatic Cyst Fluid
https://www.southcarolinablues.com/web/public/brands/medicalpolicyhb/external-policies/pancreatic-cancer-risk-testing-using-pancreatic-cyst-fluid/
PancraGEN is a DNA-based, integrated molecular pathology test that helps to assess the cancer risk in aspirated pancreatic cyst fluid. […] The authors concluded that „molecular analysis can improve the classification of pancreatic cysts as mucinous or non-mucinous. This is important as mucinous cysts are premalignant lesions and have a higher risk of concomitant pancreatic adenocarcinoma, thus implying long-term follow-up.” […] The guidelines also state that molecular testing is not routinely done because of limited data and the expense, but it does hold promise for the future.
#22 Novel Endoscopic Techniques for the Diagnosis of Pancreatic Cysts â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/august-2020/novel-endoscopic-techniques-for-the-diagnosis-of-pancreatic-cysts/
Major societies, such as the American Gastroenterological Association and the American College of Gastroenterology, have published guidelines within the last 5 years on how to manage cysts. The most commonly followed guidelines are the International Consensus Guidelines, which were last revised in 2017. In general, the size of the pancreatic cyst determines how it is managed. Cysts smaller than 1 cm can be followed with imaging studies. If cysts are between 1 and 2 cm, gastroenterologists should consider adding endoscopic ultrasound (EUS) for evaluation. Anything larger than 2 cm should certainly undergo evaluation with EUS. […] Beyond the traditional methods of cross-sectional and EUS imagingâguided cyst morphology, EUS-guided fine-needle aspiration, and analysis of cyst fluid CEA and cytology, there are multiple novel endoscopic approaches. The 3 most common techniques that are being studied are cyst fluid molecular analysis, which utilizes next-generation sequencing (NGS), EUS-guided confocal laser endomicroscopy, and EUS-guided through-the-needle forceps biopsy.
#23 Pancreatic Cysts: Risk Factors, Diagnosis & Treatment | NewYork-Presbyterian | NewYork-Presbyterian
https://www.nyp.org/digestive/pancreatic-diseases/pancreatic-cysts
Pancreatic cysts are fluid-filled cavities in the pancreas. They are usually benign, but some have the potential to become pancreatic cancer. […] Our doctors are experts in the assessment of pancreatic cysts. Some of the tools we use are not widely available elsewhere. […] Diagnosing Pancreatic Cysts […] Endoscopic ultrasound (EUS) using a special endoscope with high-energy sound waves („echoendoscope”) to see your pancreas and the pancreatic duct. […] Endoscopic retrograde cholangiopancreatography (ERCP), which combines endoscopy and x-rays to see the structure of your pancreas and any abnormalities. […] Pancreatoscopy is a way to directly visualize the pancreatic duct. […] Confocal imaging. NewYork-Presbyterian is one of few hospitals offering this highly specialized approach, which involves the use of a small microscope to analyze cells to determine if they are normal or precancerous.
#24 Novel Endoscopic Techniques for the Diagnosis of Pancreatic Cysts â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/august-2020/novel-endoscopic-techniques-for-the-diagnosis-of-pancreatic-cysts/
There is an overall improved diagnostic accuracy with the novel methods compared to the current standard of care. The 3 modalities discussed previously each have an approximate minimum accuracy rate of 90% for classifying a cyst as mucinous or nonmucinous. The novel modalities can also diagnose the specific cyst type. […] The accuracy of molecular analysis for identifying mucinous vs nonmucinous cysts has been reported in multiple studies. A single-center prospective study from the University of Pittsburgh of 102 patients who had surgical resection reported a sensitivity of 89% and specificity of 100%. […] As stated previously, IPMNs are the most common precancerous cysts and are highly prevalent in individuals 60 years of age and older. IPMNs tend to be very problematic and can cause undue anxiety to the treating physician if he or she typically does not manage pancreatic issues. Traditional and novel diagnostics play an important role.
#25 Pancreatic Cyst Symptoms, Causes and Treatment
https://www.cancercenter.com/cancer-types/pancreatic-cancer/risk-factors/pancreatic-cysts
Inflammation-related cysts are a common complication of pancreatitis, a condition in which the pancreas has become inflamed. These cysts are noncancerous (benign). […] Intraductal papillary mucinous neoplasms (IPMNs) are cysts that grow in the ducts of the pancreas. […] That same study notes that IPMNs that block the main pancreatic duct are more likely to turn cancerous than those blocking a branching duct. […] While theyre typically benign and slow-growing, they can become cancerous if left untreated. […] Less than 20 percent of MCNs are cancerous, according to the Archives of Pathology Laboratory Medicine. […] Even if an SPN has spread, surgery can be successful at removing it. […] SCNs are for the most part benign. […] Injuries and pancreatitis are the most common causes of pancreatic cysts.
#26 Diagnosis and management of cystic lesions of the pancreas – Brugge – Journal of Gastrointestinal Oncology
https://jgo.amegroups.org/article/view/4497/html
EUS is usually used to further evaluate pancreatic cysts detected by other imaging modalities and most useful to distinguish pseudocysts from other PCLs. […] EUS also allows for FNA of cystic lesions for biochemical, cytological and DNA analysis that might be further helpful for diagnosis and differentiation. […] The mean frequency of malignancy in MD-IPMN is 61.6% and the mean frequency of invasive IPMN is 43.1%. Considering these high incidences of malignant/ invasive lesions and the low 5-year survival rates (31-54%), international consensus guidelines recommend resection for all surgically fit patients with MD-IPMN. […] The mean frequency of malignancy in resected BD-IPMN is 25.5% and the mean frequency of invasive cancer is 17.7%. BD-IPMN mostly occurs in elderly patients, and the annual malignancy rate is only 2-3%. These factors support conservative management with follow-up in patients who do not have any symptoms or risk factors predicting malignancy such as mural nodule, rapidly increasing cyst size and high grade atypia in cytology. […] Current consensus guideline advocates that all MCNs should be resected, unless there are contraindications for operation. […] The mainstay of treatment is surgery. After complete surgical resection, 85% to 95% of patients are cured.
#27 Pancreas Cysts – Pancreatic Cancer | Johns Hopkins Pathology
https://pathology.jhu.edu/pancreas/ipmn/pancreas-cysts
Nonetheless, establishing the correct diagnosis of a cystic lesion in the pancreas is important for clinical management and a broad differential diagnosis should be kept in mind. […] Mucinous cystic neoplasms are neoplasms composed of mucin-producing epithelial cells associated with an ovarian-type of stroma. […] The neoplastic epithelial cells form one or more cysts that are filled with mucoid fluid and these cysts usually do not communicate with the larger pancreatic ducts. […] Mucinous cystic neoplasms have not been associated with any genetic syndromes. […] The majority (70-90%) of mucinous cystic neoplasms arise in the body or tail of the pancreas, and only a minority (10-30%) involve the head of the gland. […] The cysts have a thick-wall and are filled with thick tenacious mucoid material.
#28 New and emerging technology in the diagnosis and treatment of pancreatic cysts – Shipley – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/6166/html
Cystic lesions most at risk for malignant conversion are IPMNs, MCNs, solid pseudopapillary tumors and pancreatic neuroendocrine tumors. Current diagnostics rely on advanced cross-sectional imaging such as computed tomography (CT), magnetic resonance imaging (MRI) and cysts fluid analysis. A well trained radiologist is needed to identify high-risk stigmata on imaging. Worrisome features include a cyst 3 cm, enhancing mural nodule 5 mm, thickened/enhanced walls, non-enhanced mural nodules and a main pancreatic duct 59 mm or a rapid rate of cyst growth 5 mm/2 years. High-risk stigmata include extrahepatic biliary obstruction by a pancreatic head cyst, an enhanced solid component and a main pancreatic duct greater than 10 mm without other cause of obstruction. […] MDHCT is the preferred method for initial evaluation in patients for whom a pancreatic lesion is suspected. This modality carries a reported sensitivity of 97-100% and non-resectability prediction near 100% for pancreatic cancer lesions. However, in a retrospective study of 36 patients, the overall sensitivity, specificity and accuracy of MDHCT to discriminate benign versus malignant was 36.3%, 100% and 78.8%, respectively.
#29 Pancreatic cysts – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/pancreatic-cysts/symptoms-causes/syc-20375993
Pancreatic cysts are typically found during imaging testing for another problem. […] Your doctor might take a sample of the pancreatic cyst fluid to determine if cancer cells are present. Or your doctor might recommend monitoring a cyst over time for changes that indicate cancer. […] You may not have symptoms from pancreatic cysts, which are often found when imaging tests of the abdomen are done for another reason. […] Rarely, cysts can become infected. See a doctor if you have a fever and persistent abdominal pain. […] A ruptured pancreatic cyst can be a medical emergency, but fortunately is rare. A ruptured cyst can also cause infection of the abdominal cavity (peritonitis). […] The cause of most pancreatic cysts is unknown. […] Pseudocysts often follow a bout of a painful condition in which digestive enzymes become prematurely active and irritate the pancreas (pancreatitis). […] Heavy alcohol use and gallstones are risk factors for pancreatitis, and pancreatitis is a risk factor for pseudocysts. […] The best way to avoid pseudocysts is to avoid pancreatitis, which is usually caused by gallstones or heavy alcohol use.
#30 Pancreatic cyst endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA): Benign or malignant. Clues to cytological diagnosis with major consequences – CytoJournal
https://cytojournal.com/pancreatic-cyst-endoscopic-ultrasound-guided-fine-needle-aspiration-eus-fna-benign-or-malignant-clues-to-cytological-diagnosis-with-major-consequences/
The cytologic findings that distinguish pseudocyst from neoplastic cyst with malignant potential are summarized in Table 1. […] Pancreatic pseudocyst results from reparative changes secondary to the pancreatic parenchymal injury. Typically, pseudocysts are the result of multiple episodes of acute and chronic pancreatitis. The pseudocyst contents are rich in amylase and/or lipase and lack epithelial lining. History of recurrent pancreatitis with unilocular simple cyst is the classic clinical scenario to trigger the clinical suspicion of a pancreatic pseudocyst. […] Chemical analysis can be an useful ancillary test to support cytopathologic evaluation, The panel of chemical tests to be performed on cyst fluid should be directed based on the clinical suspicion and the amount of fluid aspirated. In general, the most useful markers to distinguish pseudocyst versus neoplastic mucinous cyst are CEA and Amylase. A pseudocyst is, by definition, a collection of amylase-rich fluid. CEA, on the other hand, is a marker of glandular epithelial cells. As a result, a typical pseudocyst would show increased amylase and low level of CEA. A reversed result is expected in neoplastic mucinous cysts.
#31 Diagnosis and management of asymptomatic neoplastic pancreatic cysts – American Gastroenterological AssociationAGA Logo_Horizontal
https://gastro.org/clinical-guidance/diagnosis-and-management-of-asymptomatic-neoplastic-pancreatic-cysts/
Diagnosis and management of asymptomatic neoplastic pancreatic cysts […] Follow this strategy to identify the small minority of pancreatic cysts with early invasive cancer or high-grade dysplasia (HGD) and to appropriately time surgical resection. […] AGA recommends that before starting any pancreatic cyst surveillance program, patients should have a clear understanding of programmatic risks and benefits. […] AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo magnetic resonance imaging (MRI) for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics. [...] AGA suggests that pancreatic cysts with at least two high-risk features, such as size â¥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with endoscopic ultrasonography (EUS) â fine-needle aspiration (FNA).
#32 Diagnosis and management of pancreatic cystic lesions for the non-gastroenterologist | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/91/2/96
Although most pancreatic cystic lesions do not progress to cancer, they create concern for patients and their primary care physicians. […] We review current guidelines on diagnosis and management. […] Magnetic resonance cholangiopancreatography with dynamic magnetic resonance imaging is the test of choice for diagnosis and assessment of high-risk or worrisome characteristics in cysts. […] High-risk clinical and laboratory features include obstructive jaundice, recurrent pancreatitis, elevated serum carbohydrate antigen 19-9, presence of cells demonstrating high-grade dysplasia or neoplasia, and new-onset or worsening diabetes. […] Pancreatic cystic lesions with high-risk features and those with a known high risk of malignancy, such as main duct intraductal papillary mucinous neoplasms and solid pseudopapillary tumors, should be referred for surgical excision.
#33 Diagnosis and management of asymptomatic neoplastic pancreatic cysts – American Gastroenterological AssociationAGA Logo_Horizontal
https://gastro.org/clinical-guidance/diagnosis-and-management-of-asymptomatic-neoplastic-pancreatic-cysts/
AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy. […] AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter â¥3 cm, are indications for EUS-FNA. […] AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate. […] AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma.
#34 Advances in the Diagnosis and Management of Pancreatic Cysts â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/january-2022/advances-in-the-diagnosis-and-management-of-pancreatic-cysts/
Why should physicians be vigilant for pancreatic cysts? […] One way to do this is to identify the precursors to pancreatic cancer. […] Proactive identification of pancreatic cysts raises the potential to detect pancreatic cancer earlier. […] When a clinician identifies a patient with a pancreatic cyst, the challenge is to differentiate IPMNs and MCNs, which can develop into pancreatic cancer, from all of the other cysts that do not need surveillance. […] Endoscopic ultrasound (EUS) and cyst fluid analysis are other important modalities that differentiate benign cysts from IPMNs and MCNs. […] The presence of symptoms or signs such as jaundice, acute pancreatitis secondary to the cyst, or an elevated carbohydrate antigen 19-9 is concerning, as is the presence of a mural nodule or enhancing mass, an enlarged pancreatic duct of 5 mm or greater, a large cyst (>3 cm) on imaging, or the presence of high-grade dysplasia or adenocarcinoma on cytology.
#35
https://journals.lww.com/ajg/fulltext/2018/04000/acg_clinical_guideline__diagnosis_and_management.8.aspx
Patients with asymptomatic cysts that are diagnosed as pseudocysts on initial imaging and clinical history, or that have a very low risk of malignant transformation (such as SCAs) do not require treatment or further evaluation. […] Cyst surveillance should be offered to surgically fit candidates with asymptomatic cysts that are presumed to be IPMN or MCNs. […] Patients with IPMNs or MCNs with new onset or worsening diabetes mellitus, or a rapid increase in cyst size (of 3mm/year) during surveillance, may have an increased risk of malignancy so should undergo a short-interval MRI or EUSFNA.
#36 So you’ve discovered a pancreatic cyst … | I.M. Matters from ACP
https://immattersacp.org/archives/2019/06/so-youve-discovered-a-pancreatic-cyst.htm
Internists should follow a stepwise progression of diagnosis and management of pancreatic cysts. […] The next step in this case is to order a pancreatic-protocol CT or MRI/magnetic resonance cholangiopancreatography (MRCP), or refer for endoscopic ultrasound (EUS). […] Worrisome imaging findings include cysts 3 cm in diameter or larger, an abrupt change in the main pancreatic duct, main-duct dilation that is 5 mm or more in diameter and focal dilation of the main pancreatic duct, and a mural nodule or a solid component. […] Patients should also be referred to EUS or to a subspecialist if they present with jaundice secondary to a cyst or have elevated serum CA19-9 levels along with a cyst, she noted. […] EUS can also help identify cysts based on appearance. […] Management and surveillance of unresected cysts are primarily guided by size, Dr. Anderson said.
#37 Updates in diagnosis and management of pancreatic cysts
https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm
Cyst fluid for cytology typically has low diagnostic yield with less than 50% sensitivity for mucinous lesions, however, it is helpful when positive for a specific diagnosis. […] While CEA is not predictive of malignancy, it remains the most widely used and accurate tumor marker for differentiating mucinous from non-mucinous pancreatic cysts. […] Surgery should be considered for patients with cysts that are symptomatic, malignant, or at high-risk for malignancy. […] Stratifying the malignant risk of a pancreatic cyst is simplest when the diagnosis of the cyst is known, but also possible for indeterminate cysts by assessing for risk features. […] Patients with cysts at low risk for malignancy and following resection of certain cysts should undergo surveillance. […] While the various guidelines provide a foundation for managing pancreatic cysts, the approach to each patient with a pancreatic cyst should be individualized based on clinical status and comorbidities, risk of malignancy, and personal preferences.
#38 So you’ve discovered a pancreatic cyst … | I.M. Matters from ACP
https://immattersacp.org/archives/2019/06/so-youve-discovered-a-pancreatic-cyst.htm
Cysts that are less than a centimeter in size can be scanned every two years for four years, versus those greater than 3 cm, which should be referred to a multidisciplinary team. […] Internists following unresected cysts with interval imaging should refer patients who develop new-onset diabetes, especially if they have a normal body mass index, Dr. Anderson said. […] Patients who have undergone resection and have been diagnosed with a mucinous cystic neoplasm (MCN) do not need surveillance, Dr. Anderson said. […] Those with low-grade dysplasia or moderate dysplasia should undergo a history and physical and MRI or EUS every six months.
#39 Diagnostics and Management of Pancreatic Cystic LesionsâNew Techniques and Guidelines
https://www.mdpi.com/2077-0383/13/16/4644
The assessment of a patient with an inadvertent pancreatic cyst should begin with a thorough history, focusing on episodes of acute or chronic pancreatitis. […] The International Consensus Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms (IPMNs) were initially introduced in 2006 at the 11th International Association of Pancreatology (IAP) meeting in Sendai, Japan. […] The latest guidelines, published in 2024 following the 2022 meeting in Kyoto, Japan, included updates on HRS and WFs, surveillance protocols for non-resected IPMN, post-resection surveillance, and the investigation of molecular markers in cyst fluid. […] The management of MCN is also addressed in the 2018 âACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts.â […] The European evidence-based guidelines (2018) also address the management of MCNs. The guidelines recommend surveillance for asymptomatic MCN < 40 mm without a contrast-enhancing mural nodule in MRI. [...] The combination of these genetic markers enhances the diagnostic capabilities of EUS-FNA, allowing for more accurate stratification of cystic lesions and personalized treatment plans.
#40 Diagnosis and management of pancreatic cystic lesions for the non-gastroenterologist | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/91/2/96
PCLs that have the potential to become malignant are managed by active monitoring or surgical excision. […] PCLs with high-risk characteristics, and those with a known high risk of malignancy, such as main duct intraductal papillary mucinous neoplasms and solid pseudopapillary tumors, should be referred for surgical excision. […] Patients with asymptomatic cysts and those without high-risk characteristics can undergo active surveillance, as the likelihood of advanced neoplasia is low. […] The overall prognosis is favorable, with early detection and active surveillance serving as the cornerstones of management.
#41 Diagnosis and management of asymptomatic neoplastic pancreatic cysts – American Gastroenterological AssociationAGA Logo_Horizontal
https://gastro.org/clinical-guidance/diagnosis-and-management-of-asymptomatic-neoplastic-pancreatic-cysts/
AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery. […] AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years. […] AGA suggests against routine surveillance of pancreatic cysts without high-grade dysplasia or malignancy at surgical resection.
#42 Pancreatic cystic lesions. Differential diagnosis and treatment strategy | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-pancreatic-cystic-lesions-differential-diagnosis-articulo-S2255534X22000305
EUS is an essential tool in the evaluation of IPCLs. It provides high-resolution images and facilitates the acquisition of cyst fluid and tissue from the interior and wall of the cyst, using fine needles. […] The data collected from the aforementioned clinical analysis and imaging techniques make the identification of certain lesions, such as pseudocysts and SCA, relatively easy. Others have yet to be properly differentiated, such as simple cysts and those with a high risk for malignancy, some of which require immediate surgery (MCA, solid pseudopapillary tumor, MD-IPMN), whereas others (BD-IPMN) can be conservatively managed. […] The presence of worrisome features or high-risk features, a cytology suggestive of or positive for malignancy, main pancreatic duct dilatation 1cm (with no signs of secondary obstruction or chronic pancreatitis), or high suspicion of MD-IPMN or mixed-type IPMN are indications for surgical resection.
#43 Diagnosis and Management of Pancreatic Cysts
https://www.mdcalc.com/guidelines/10393/acg/diagnosis-management-pancreatic-cysts
Diagnosis […] We recommend caution when attributing symptoms to a pancreatic cyst. The majority of pancreatic cysts are asymptomatic and the nonspecific nature of symptoms requires clinical discernment. […] Magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP) are the tests of choice because of their non-invasiveness, lack of radiation, and greater accuracy in assessing communication between the main pancreatic duct and the cyst (which is a characteristic of side-branch IPMNs). Pancreatic protocol computed tomography (CT) or endoscopic ultrasound (EUS) are excellent alternatives in patients who are unable to undergo MRI. Indeterminate cysts may benefit from a second imaging modality or cyst fluid analysis via EUS. […] Use caution when using imaging to diagnose cyst type or concomitant malignancy; the accuracy of MRI or MRCP in diagnosing cyst type is 4050% and in determining benign vs. malignant is 5576%. The accuracy for CT and EUS without FNA is similar.
#44 Guidelines for the Diagnosis and Management of Pancreatic Cystic Neoplasms – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/guidelines-for-the-diagnosis-and-management-of-pancreatic-cystic-neoplasms/
Based on the latest developments in diagnostic modalities and a review of current guidelines, including the AGA, The IAP, and the European Study Group on Cystic Tumors of the Pancreas (European), this report discussed recommendations for the diagnosis and management of pancreatic cystic neoplasms (PCN). […] The investigators summarized existing diagnostic and follow-up strategies and indications for surgery, highlighting important differences in the existing guidelines, and addressed new developments in the management of patients with PCN. […] The primary goal of these guidelines is to prevent malignancy and alleviate symptoms; recommendations of surveillance and surgical resection are made on the basis of symptoms and perceived risk of malignancy. […] The investigators suggest that MRI with MRCP is the preferred method of follow-up for newly diagnosed PCN, as repeated radiation exposure following CT may increase the risk of malignancy.
#45 Updates in diagnosis and management of pancreatic cysts
https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm
Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines. […] Evaluating a patient with an incidental pancreatic cyst should begin with a targeted history focused on acute or chronic pancreatitis and family history of pancreatic cancer or hereditary cancer syndromes associated with increased risk of pancreatic cancer. […] MRI has 55% to 76% accuracy for differentiating benign from malignant cysts while it is only 40% to 50% accurate for diagnosing the specific type of cyst. […] The imaging findings will help determine whether EUS is needed for further diagnostic evaluation, the patient should undergo surgical resection, or begin a surveillance program. […] The overarching questions when reviewing imaging are: (1) Is the cyst malignant; (2) If not, is it a mucinous cyst; and (3) If it is a mucinous cyst, what is the malignant potential?
#46 Molecular insights into pancreatic cysts: navigating diagnosis and precision management
https://www.explorationpub.com/Journals/edd/Article/100571
Surgical resection is generally recommended in all patients with MCN, MD-IPMN, mixed duct-IPMN, and BD-IPMN with high-risk stigmata or several worrisome features in surgically fit patients. […] The ability to discern malignant from benign cysts is limited on cross-sectional imaging. Imaging modalities and endoscopic ultrasound (EUS) have limitations in both accurately distinguishing the different subtypes of PCL, as well as discerning the risk of advanced neoplasia. […] Cyst fluid analysis has emerged as an investigation tool that can guide clinical decision making. […] The effectiveness of EUS is highlighted when combined with FNA of pancreatic cyst fluid. EUS-guided-FNA for cyst fluid analysis including fluid cytology and different biochemical markers help bridge the void of inaccurate diagnosis as well as providing a reliable tool to accurately predict the risk of advanced neoplasia among the different PCL types.
#47 Your Pancreatic Cyst Treatment Options | Fox Chase Cancer Center – Philadelphia PA
https://www.foxchase.org/clinical-care/conditions/pancreatic-cancer/pancreatic-cyst/treatment
Diagnosing and caring for patients with pancreatic cysts is best done through a multidisciplinary approach. […] At Fox Chase, your specialized team of surgeons, radiologists, and gastroenterologists collaborate on confirming your diagnosis and developing the best course of treatment. […] The specialists at Fox Chase will work closely with you to determine the appropriate treatment plan for your pancreatic cyst. […] If your pancreatic cyst contains benign cells and presents no high-risk features on imaging tests, it probably wont have to be removed. […] For mucin-producing cysts that are considered precancerous including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) surgical removal is often recommended to avoid future occurrence of cancer. […] Your pancreatic team will determine whether an IPMN is arising from the main pancreatic duct or from a side branch of the duct.
#48 Cyst Clinic: IPMNs and Other Cystic Tumors – Pancreatic Cancer | Johns Hopkins Pathology
https://pathology.jhu.edu/pancreas/cyst-clinic
Your physician will discuss in detail the findings of your imaging as well as what we suspect is the diagnosis of the pancreatic cyst based on history and imaging. […] In some cases, further tests may be required, such an endoscopic procedure. […] In some cases, your case may be discussed at the bimonthly multidisciplinary pancreatic cyst meeting which is attended by gastroenterologist, surgeons, pathologists, and radiologists. […] You will be provided with information about ongoing trials for pancreatic cysts at Johns Hopkins at the time of their clinic visit. […] A fluid filled sac. Some tumors of the pancreas, including the serous cystadenomas and intraductal papillary mucinous neoplasms, form cysts. Cysts have a distinct appearance in CT scans. They are important to recognize because the treatment of cystic tumors can differ from that for solid tumors.
#49 New and emerging technology in the diagnosis and treatment of pancreatic cysts – Shipley – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/6166/html
EUS-FNI is a minimally invasive approach used to deliver specific chemotherapeutic agents or other anti-tumor agents in those with pancreatic cysts and local control of tumor growth if the lesion is non-resectable. Agents used in cysts include ethanol and chemotherapeutic agents such as paxitaxel. In a study of 25 patients with cystic lesions, ethanol lavage was performed via EUS-FNI and 35% of patients had complete resolution of their cysts. […] The diagnosis and treatment of pancreatic cysts remains challenging. The frequent detection of a pancreatic cyst is becoming more common due to new advanced imaging modalities and the frequency of their use in clinical practice. Management decision for asymptomatic pancreatic cysts must involve a multidisciplinary team and balance risk for malignancy with the complications of pancreatic surgery.
#50
https://link.springer.com/article/10.1007/s10620-021-07084-1
Despite these findings, there a few limitations to highlight. […] The place of EUS-nCLE in the algorithm for evaluating PCLs remains to be determined. […] The authors suggested algorithm for approaching incidental pancreatic cysts provides a framework for approaching these lesions. […] The need for minimally invasive treatment of PCLs has led to the development of EUS-guided cyst ablation, designed to destroy the neoplastic epithelial lining of the cyst in patients who decline or are not operative candidates. […] While the majority of cysts may be followed with MRI likely without gadolinium, careful appreciation for when to stop surveillance in higher-risk patients, when to refer for EUS in the presence of worrisome or high-risk features or indeterminate cysts, and when to consider surgical resection is essential.
#51 Molecular insights into pancreatic cysts: navigating diagnosis and precision management
https://www.explorationpub.com/Journals/edd/Article/100571
Although CT and MRI are able to detect PCL at high frequencies, these modalities have limitations when it comes to distinguishing the different types based on morphologic features alone. […] Despite advancements in imaging, endoscopic, cytopathologic and biomarker analysis, identifying precisely which PCL harbors malignancy or is at risk of progression remains a challenge.
#52 Pancreatic Cysts | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/pancreatic-cysts
Most pancreatic cysts are benign (not cancer) and have a low chance of causing harm or symptoms. But some are precancerous, which means they can become pancreatic cancer. Its important to find out what type of cyst you have. […] MSK uses the latest imaging methods, new technology that can find many more cases of pancreatic cysts. […] Our pancreatic cyst specialists recommend that people diagnosed with cysts should be closely monitored. […] The program will monitor you throughout your life. Its important to know you may still need ongoing monitoring even after we remove the cysts during surgery. […] Our researchers are also exploring biomarkers, such as proteins and genes. They can help us know which cysts are benign (not cancer) or precancerous. […] This information can help predict whether a precancerous cyst will turn into cancer. It guides decisions about monitoring and treatment.
#53 Cystic pancreatic lesions: MR imaging findings and management | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01060-z
In fit patients, resection is recommended also in MCN without radiological features of malignant degeneration, due to its high malignant potential. […] However, in elderly patients with comorbidities follow-up may be an option if lesion is smaller than 4 cm and if mural nodules are absent. […] Surveillance is recommended with MRI, EUS or a combination of both every 6 months for the first year and then annually if no changes are observed. […] Patients with IPMN without high-risk stigmata and patients who have been resected for an IPMN need follow-up till they are fit for surgery, in order to early detect malignant degeneration or concomitant pancreatic ductal adenocarcinoma. […] When the diagnosis of a CPL remains indeterminate, in our opinion it should be managed as an IPMN, as they are the most frequent CPLs with a potential malignant behavior. […] New imaging applications, with quantitative analysis thanks to texture analysis, have the potential to help to better stratify IPMNs, thus allowing a more correct management.
#54 Algorithm Helps Physicians Better Detect Concerning Pancreatic Cysts | University Hospitals
https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2020/10/algorithm-helps-physicians-better-detect-concerning-pancreatic-cysts
Pancreatic cysts usually arent cause for concern. But when they are, early detection and treatment can prevent these cysts from progressing to pancreatic cancer. […] To streamline and standardize diagnosis and treatment, Dr. Winter and team developed a pancreatic cyst algorithm for concerning findings. The current version of the algorithm has been in place for about a year and helps physicians determine the proper path to treatment. […] It will take time before Dr. Winter and Dr. Hardacre have data to show whether their process helps lower the cancer rate. However, early benefits are encouraging. Were not only improving the notification process and the time to getting a biopsy or a referral, were improving time to treatment, Dr. Winter says. […] The cyst identification and notification process and the virtual surgical consultation show how the UH Digestive Health Institute is improving its personalized, comprehensive pancreas cancer care.