Materiały źródłowe

• #1 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. […] To date only a few studies have been performed investigating the true prevalence of pancreatic cysts. […] A prevalence of 2.4% and increased with age was found in a study where 2803 magnetic resonance imaging (MRI) examinations were retrospectively reviewed. […] A study by Laffan et al. reported a prevalence of 2.6%. […] A prevalence of 13.5% was found in another recent retrospective study in 616 patients using MRI. […] In all these studies increasing age correlated with a higher prevalence of pancreatic cysts. […] The broad range of prevalence values can be explained by the fact that studies differed in the selection of the study population, in-hospital or out-patient based and whether patients with potential pancreatic disease were excluded from analysis.

• #2 Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines

  https://www.mdpi.com/2077-0383/12/12/4020

  Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. […] Up to 2% of pancreatic cysts represent an incidental finding during CT or MRI for unrelated reasons, which can be grouped into pancreatic cysts that are either neoplastic or non-neoplastic (with their most frequently recognized forms being inflammatory fluid collections). […] Recent data from the literature show that the prevalence of pancreatic cysts can reach 49.1%, with a 12.9% incidence at a 5-year follow-up, whilst other reports present prevalence ranging from 2.4 to up to 13.5%. […] One of the most important steps in this regard is to separate benign from potentially malignant lesions since systematic reviews have shown that the risk of malignant transformation reaches 0.24% per year.

• #3 How many pancreatic cysts are out there and how to best manage them? – Ciofoaia – Translational Cancer Research

  https://tcr.amegroups.org/article/view/20303/15984

  In this study by Kromrey et al., an asymptomatic population cohort had two MRIs performed 5 years apart, leading to an unexpectedly high 49.1% prevalence of pancreatic cystic lesions and new incidence of lesions of 12.9%. […] The robust AGA technical review identified 7 studies that reported based on MRI the prevalence of pancreatic cysts to range from 2% to 38%, with an overall prevalence of 15%. […] In the current study, 57% of the patients with pancreatic cysts had an increase in size in 5 years and other studies also suggested that pancreatic cysts still continue to grow 2.2 years later with 11% of them showing delayed growth even after an initial 1-year period of stability. […] The clinical management of pancreatic cystic lesions is currently based on the AGA guideline for incidental asymptomatic cysts and the Sendai guidelines 2006 and their 2012 and 2017 revision – the Fukuoka guidelines for mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, the small percentage of the pancreatic cystic lesions with an established malignant potential.

• #4 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. The lack of consensus guidelines on diagnosis and surveillance of these lesions can lead to a management conundrum. We review current guidelines on diagnosis and management. […] The prevalence of PCLs in the general population has not been thoroughly investigated due to the inherent difficulty of examining a typically asymptomatic condition. Due to the increased use of abdominal imaging and developments in high-resolution cross-sectional imaging, the prevalence of PCLs has gradually increased over the past 10 years. […] The estimated prevalence also varies according to geographical region, with an estimated frequency of 12.6% in the United States and South America, 8.6% in Europe, and 3.1% in Asia.

• #5 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-24/pancreas-pancreatic-cysts-lesions-imaging/75191

  Pancreatic cystic lesions are being found more frequently on cross-sectional imaging studies. The incidence of pancreatic cystic lesions is increasing, partly due to the aging population, the increased use of cross-sectional imaging studies, and, perhaps, other reasons that are unclear. The prevalence of pancreatic cysts increases with age; it has an approximate overall incidence of 15% on MRI, with meta-analysis data showing this number increases from 9% in people aged 50 to 59 years to as high as 38% in those aged 80 years and older. […] High-resolution cross-sectional imaging in the form of CT or MRI allows for noninvasive assessment and characterization of these lesions, whereas endoscopic ultrasound (EUS) is more invasive but allows for the most sensitive assessment and diagnostic sampling.

• #6 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. […] To date only a few studies have been performed investigating the true prevalence of pancreatic cysts. […] A prevalence of 2.4% and increased with age was found in a study where 2803 magnetic resonance imaging (MRI) examinations were retrospectively reviewed. […] A study by Laffan et al. reported a prevalence of 2.6%. […] A prevalence of 13.5% was found in another recent retrospective study in 616 patients using MRI. […] In all these studies increasing age correlated with a higher prevalence of pancreatic cysts. […] The broad range of prevalence values can be explained by the fact that studies differed in the selection of the study population, in-hospital or out-patient based and whether patients with potential pancreatic disease were excluded from analysis.

• #7 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-21/Pancreatic-Cystic-Lesions/64972

  Pancreatic cysts are a biologically diverse group of lesions that have varying degrees of malignant potential. Due to the widespread use of cross-sectional imaging, these lesions are increasingly being detected incidentally. […] It is estimated that pancreatic cysts are identified in approximately 3% of patients who undergo CT and up to 13.5% in older patients undergoing MRI. The management of pancreatic cysts requires accurate risk stratification for malignant potential based on the presence or absence of symptoms and high-risk features on imaging. […] Available guidelines recommend some form of long-term surveillance of patients with IPMNs. There are differences in surveillance intervals between the various guidelines, but most guidelines suggest that small cysts (3 cm) in asymptomatic patients without any suspicious features may be observed with serial imaging because the risk for malignancy is low. The surveillance interval is based on the size of the cyst and varies between guidelines but generally is every 2 years for cysts under 1 cm, every year for cysts between 1 and 2 cm, and every 6 months for cysts between 2 and 3 cm.

• #8 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-24/pancreas-pancreatic-cysts-lesions-imaging/75191

  Pancreatic cystic lesions are being found more frequently on cross-sectional imaging studies. The incidence of pancreatic cystic lesions is increasing, partly due to the aging population, the increased use of cross-sectional imaging studies, and, perhaps, other reasons that are unclear. The prevalence of pancreatic cysts increases with age; it has an approximate overall incidence of 15% on MRI, with meta-analysis data showing this number increases from 9% in people aged 50 to 59 years to as high as 38% in those aged 80 years and older. […] High-resolution cross-sectional imaging in the form of CT or MRI allows for noninvasive assessment and characterization of these lesions, whereas endoscopic ultrasound (EUS) is more invasive but allows for the most sensitive assessment and diagnostic sampling.

• #9 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. […] To date only a few studies have been performed investigating the true prevalence of pancreatic cysts. […] A prevalence of 2.4% and increased with age was found in a study where 2803 magnetic resonance imaging (MRI) examinations were retrospectively reviewed. […] A study by Laffan et al. reported a prevalence of 2.6%. […] A prevalence of 13.5% was found in another recent retrospective study in 616 patients using MRI. […] In all these studies increasing age correlated with a higher prevalence of pancreatic cysts. […] The broad range of prevalence values can be explained by the fact that studies differed in the selection of the study population, in-hospital or out-patient based and whether patients with potential pancreatic disease were excluded from analysis.

• #10 Pancreatic Cyst: Symptoms, Causes, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/pancreatic-cyst

  A pancreatic cyst is a type of tumor that grows on or in your pancreas. Its typically liquid inside, with an outer skin. Less than 1% of pancreatic cysts become cancerous, but healthcare providers keep them under surveillance just in case. […] Studies suggest that approximately 10% of CT scans (computed tomography scans) and MRIs (magnetic resonance imaging) discover pancreatic cysts. Theyre usually an accidental finding on imaging tests taken for another reason. Since most pancreatic cysts dont cause symptoms, we dont know how many other people might have them without being aware of it. […] 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. Most precancerous cysts grow and change very slowly, so regular surveillance is likely to spot cancerous changes early in the process.

• #11 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. […] 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. […] Many kinds of cysts can grow on the pancreas, some cancerous and some benign. […] Watchful waiting or treatment depends on the type of cyst you have, its size, its characteristics and whether it’s causing symptoms. […] Some types of pancreatic cysts require surgical removal because of the risk of cancer.

• #12 Pancreatic Cyst: Symptoms, Causes, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/pancreatic-cyst

  A pancreatic cyst is a type of tumor that grows on or in your pancreas. Its typically liquid inside, with an outer skin. Less than 1% of pancreatic cysts become cancerous, but healthcare providers keep them under surveillance just in case. […] Studies suggest that approximately 10% of CT scans (computed tomography scans) and MRIs (magnetic resonance imaging) discover pancreatic cysts. Theyre usually an accidental finding on imaging tests taken for another reason. Since most pancreatic cysts dont cause symptoms, we dont know how many other people might have them without being aware of it. […] 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. Most precancerous cysts grow and change very slowly, so regular surveillance is likely to spot cancerous changes early in the process.

• #13 The Radiology Assistant : Pancreatic cystic Lesions

  https://radiologyassistant.nl/abdomen/pancreas/pancreas-cystic-lesions

  Mucinous cystic neoplasm is exclusively seen in middle-aged women with a mean age of 47 years. […] Serous cystic neoplasm is also most commonly seen in women (75%) with a median age of 58 years. […] IPMN is a lesion with malignant potential. […] The frequency of imaging follow-up depends on the presence of indications and fitness for surgery as can be seen in the table. […] However in suspected Mucinous Cystic Neoplasm a cyst size 4 cm is an absolute criterium for resection, whereas for IPMN it is a relative indication.

• #14 The Radiology Assistant : Pancreatic cystic Lesions

  https://radiologyassistant.nl/abdomen/pancreas/pancreas-cystic-lesions

  Mucinous cystic neoplasm is exclusively seen in middle-aged women with a mean age of 47 years. […] Serous cystic neoplasm is also most commonly seen in women (75%) with a median age of 58 years. […] IPMN is a lesion with malignant potential. […] The frequency of imaging follow-up depends on the presence of indications and fitness for surgery as can be seen in the table. […] However in suspected Mucinous Cystic Neoplasm a cyst size 4 cm is an absolute criterium for resection, whereas for IPMN it is a relative indication.

• #15 About Pancreatic Cysts | Fox Chase Cancer Center – Philadelphia PA

  https://www.foxchase.org/clinical-care/conditions/pancreatic-cancer/pancreatic-cyst/about

  Most pancreatic cysts are benign (noncancerous) and stem from conditions other than cancer such as inflammation associated with pancreatitis, or as a result of abdominal trauma. […] However, some cysts are considered precancerous, and a small percentage are malignant or can become cancerous over time. […] For the reasons above, your physician may want to conduct further evaluation of your pancreatic cyst. […] It is important to see a specialist who can determine the appropriate plan for diagnosis and treatment, which could consist of a biopsy, imaging tests, regular surveillance, or surgical removal. […] Mucin-producing cysts have the potential to become malignant, especially if they are larger or have a thickened wall that lights up with contrast on imaging. […] It is difficult to predict whether an IPMN will become cancerous, but cysts in the main pancreatic duct have a significantly higher rate of malignancy. […] Mucinous cystic neoplasms (MCNs), which occur primarily in women, have the potential to become cancerous because of nodules or growths on the cyst walls.

• #16 Pancreatic Cyst Surveillance Program

  https://www.rwjbh.org/cooperman-barnabas-medical-center/treatment-care/cancer/types-of-cancer/gastrointestinal-cancer/types-of-cancers-we-treat/pancreatic-cancer/pancreatic-cyst-surveillance-program/

  As a high-volume pancreatic cancer center, Cooperman Barnabas Medical Center partnered with Eon, a health care technology company, to create a first of its kind digital platform to identify, track, follow and monitor patients with pancreatic cysts. This program uses a new cloud-based system that automatically highlights patients when incidental scans, such as an MRI, CT scan or ultrasound, discover pancreatic cysts, so at-risk people can be contacted for potential follow-up. […] Patients who elect to enroll in The Pancreatic Cyst Surveillance Program at Cooperman Barnabas are followed by a pancreatic expert who will stratify and assess the risk of the cyst becoming cancerous. […] Around 15 percent of Americans are walking around with a pancreatic cyst. Of those, the risk of the cyst becoming cancerous can be as high as 60 percent and as low as 2 percent. Some cysts dont require immediate surgery but should be monitored regularly for particular changes that may suggest an increased risk of malignancy. […] This program helps determine the appropriate time to operate on patients, but also when to keep patients out of the operating room to prevent them from having unnecessary surgeries when the risk of complications is greater than the risk of cancer.

• #17 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.

• #18 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pancreatic cysts (PC) are an increasingly common problem facing general gastroenterologists and generalists. They can be divided into 3 groups. First, those that have no risk of developing into pancreatic cancer, such as a pseudocyst or serous cystadenomas (SCAs). Second, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), which are precursor lesions to high-grade dysplasia and pancreatic cancer. Third, solid cancers of the pancreas, such as neuroendocrine tumors and pancreatic adenocarcinomas, which have undergone cystic degeneration. […] The American College of Gastroenterology (ACG), the American Gastrointestinal Association (AGA), European, American College of Radiology (ACR), and International Association of Pancreatology (IAP) group (also known as the Fukuoka) have developed PC guidelines.

• #19 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pancreatic cysts (PC) are an increasingly common problem facing general gastroenterologists and generalists. They can be divided into 3 groups. First, those that have no risk of developing into pancreatic cancer, such as a pseudocyst or serous cystadenomas (SCAs). Second, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), which are precursor lesions to high-grade dysplasia and pancreatic cancer. Third, solid cancers of the pancreas, such as neuroendocrine tumors and pancreatic adenocarcinomas, which have undergone cystic degeneration. […] The American College of Gastroenterology (ACG), the American Gastrointestinal Association (AGA), European, American College of Radiology (ACR), and International Association of Pancreatology (IAP) group (also known as the Fukuoka) have developed PC guidelines.

• #20 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pancreatic cysts (PC) are an increasingly common problem facing general gastroenterologists and generalists. They can be divided into 3 groups. First, those that have no risk of developing into pancreatic cancer, such as a pseudocyst or serous cystadenomas (SCAs). Second, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), which are precursor lesions to high-grade dysplasia and pancreatic cancer. Third, solid cancers of the pancreas, such as neuroendocrine tumors and pancreatic adenocarcinomas, which have undergone cystic degeneration. […] The American College of Gastroenterology (ACG), the American Gastrointestinal Association (AGA), European, American College of Radiology (ACR), and International Association of Pancreatology (IAP) group (also known as the Fukuoka) have developed PC guidelines.

• #21 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pancreatic cysts (PC) are an increasingly common problem facing general gastroenterologists and generalists. They can be divided into 3 groups. First, those that have no risk of developing into pancreatic cancer, such as a pseudocyst or serous cystadenomas (SCAs). Second, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), which are precursor lesions to high-grade dysplasia and pancreatic cancer. Third, solid cancers of the pancreas, such as neuroendocrine tumors and pancreatic adenocarcinomas, which have undergone cystic degeneration. […] The American College of Gastroenterology (ACG), the American Gastrointestinal Association (AGA), European, American College of Radiology (ACR), and International Association of Pancreatology (IAP) group (also known as the Fukuoka) have developed PC guidelines.

• #22 Updates in diagnosis and management of pancreatic cysts

  https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm

  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. […] The American Gastroenterological Association (AGA) technical review of incidental pancreatic cysts estimated incident risk of malignancy at 0.24% per year with a prevalent malignant risk of 0.25% at the time the cyst is identified. […] Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines. […] MRI pancreas with magnetic resonance cholangiopancreatography in 1.5 or 3 tesla should be performed. 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.

• #23 Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines

  https://www.mdpi.com/2077-0383/12/12/4020

  Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. […] Up to 2% of pancreatic cysts represent an incidental finding during CT or MRI for unrelated reasons, which can be grouped into pancreatic cysts that are either neoplastic or non-neoplastic (with their most frequently recognized forms being inflammatory fluid collections). […] Recent data from the literature show that the prevalence of pancreatic cysts can reach 49.1%, with a 12.9% incidence at a 5-year follow-up, whilst other reports present prevalence ranging from 2.4 to up to 13.5%. […] One of the most important steps in this regard is to separate benign from potentially malignant lesions since systematic reviews have shown that the risk of malignant transformation reaches 0.24% per year.

• #24 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-21/Pancreatic-Cystic-Lesions/64972

  The risk for malignancy associated with IPMNs depends on the type. MD-IPMNs and mixed-type IPMNs have a higher risk for malignancy compared with BD-IPMNs; the elevated risk was up to 60% in surgical series of resected lesions, but selection bias is a significant limitation of these data. The risk for malignant transformation of BD-IPMNs is much lower. In a study of 1,404 consecutive patients with BD-IPMNs, the overall incidence rate of pancreatic carcinoma 5, 10, and 15 years after IPMN diagnosis was 3.3%, 6.6%, and 15%, respectively. […] The management of MCNs requires a multidisciplinary approach. Surgical resection should be considered in large MCNs with high-risk features on imaging. Surveillance may be appropriate for smaller lesions without high-risk features. If resection is offered and the lesion is completely resected on pathology, postoperative surveillance usually is not required.

• #25 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-21/Pancreatic-Cystic-Lesions/64972

  The risk for malignancy associated with IPMNs depends on the type. MD-IPMNs and mixed-type IPMNs have a higher risk for malignancy compared with BD-IPMNs; the elevated risk was up to 60% in surgical series of resected lesions, but selection bias is a significant limitation of these data. The risk for malignant transformation of BD-IPMNs is much lower. In a study of 1,404 consecutive patients with BD-IPMNs, the overall incidence rate of pancreatic carcinoma 5, 10, and 15 years after IPMN diagnosis was 3.3%, 6.6%, and 15%, respectively. […] The management of MCNs requires a multidisciplinary approach. Surgical resection should be considered in large MCNs with high-risk features on imaging. Surveillance may be appropriate for smaller lesions without high-risk features. If resection is offered and the lesion is completely resected on pathology, postoperative surveillance usually is not required.

• #26 Pancreatic Cyst: Symptoms, Causes, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/pancreatic-cyst

  A pancreatic cyst is a type of tumor that grows on or in your pancreas. Its typically liquid inside, with an outer skin. Less than 1% of pancreatic cysts become cancerous, but healthcare providers keep them under surveillance just in case. […] Studies suggest that approximately 10% of CT scans (computed tomography scans) and MRIs (magnetic resonance imaging) discover pancreatic cysts. Theyre usually an accidental finding on imaging tests taken for another reason. Since most pancreatic cysts dont cause symptoms, we dont know how many other people might have them without being aware of it. […] 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. Most precancerous cysts grow and change very slowly, so regular surveillance is likely to spot cancerous changes early in the process.

• #27 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. […] While benign cysts usually dont require further treatment, cancerous or precancerous cysts require ongoing surveillance or surgery. […] 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. […] In an article for Translational Cancer Research, Nathan Berger, MD, a member of the GI Cancer Genetics Program at the Case Comprehensive Cancer Center and Professor of Medicine, Biochemistry, Oncology, Genetics and Genome Sciences at the School of Medicine, noted that a Mayo Clinic study that found the five-year risk for developing pancreatic cancer was 49.7 percent in high-risk groups (obstructive jaundice, cystic lesions in pancreas head, solid components within cysts, thickened or enhancing cyst wall, or main duct dilatation 10 mm), while the risk for those with worrisome features (pancreatitis without other causes, cysts 3 cm, thickened walls, main duct dilatation 59 mm, mural nodules, lymphadenopathy, abrupt change in duct dilatation with distal pancreatic atrophy) was 5.1 percent.

• #28 13 Tips for Pancreatic Cyst Surveillance

  https://www.medscape.com/viewarticle/977133

  The ever-increasing use of radiographic imaging of the abdomen, in particular by CT and MRI, has led to a significant rise in the discovery of patients with pancreatic cysts. […] Over the past few years, guidelines on this topic have been published by the American Gastroenterological Association, the American College of Gastroenterology, the American College of Radiology, and the European Study Group on Cystic Tumours of the Pancreas. […] A main through-line in the various guidelines is the importance of determining the type of cyst and risks for neoplasia. […] High-risk features of IPMNs include jaundice due to cyst-related biliary compression, pancreatic duct of 10 mm, mural nodule of 5 mm or solid mass, and/or cytology with high-grade dysplasia or cancer. […] Worrisome features for pancreatic neoplasia include acute pancreatitis, mural nodule of 5 mm, main pancreatic duct size of 5-9 mm, abrupt pancreatic duct caliber changes, increased serum level of CA 19-9, cyst 3 cm, or rapid increases in size (2.5-5 mm/year).

• #29 Pancreatic cyst – Wikipedia

  https://en.wikipedia.org/wiki/Pancreatic_cyst

  A pancreatic cyst is a fluid filled sac within the pancreas. The prevalence of pancreatic cysts is 2-15% based on imaging studies, but the prevalence may be as high as 50% based on autopsy series. Most pancreatic cysts are benign and the risk of malignancy (pancreatic cancer) is 0.5-1.5%. Pancreatic pseudocysts and serous cystadenomas (which collectively account for 15-25% of all pancreatic cysts) are considered benign pancreatic cysts with a risk of malignancy of 0%. […] Pancreatic cysts are usually seen incidentally when medical imaging is obtained for other purposes and they are usually asymptomatic. Pancreatic cysts may sometimes be definitively diagnosed based on imaging findings from an MRI or CT scan with contrast. […] Based on imaging, cysts that cause biliary obstruction, dilation of the main pancreatic duct greater than 10 mm, have a mass in their walls greater than 5 mm are considered high risk features and are associated with a 56-89% risk of cancer.

• #30 13 Tips for Pancreatic Cyst Surveillance

  https://www.medscape.com/viewarticle/977133

  The ever-increasing use of radiographic imaging of the abdomen, in particular by CT and MRI, has led to a significant rise in the discovery of patients with pancreatic cysts. […] Over the past few years, guidelines on this topic have been published by the American Gastroenterological Association, the American College of Gastroenterology, the American College of Radiology, and the European Study Group on Cystic Tumours of the Pancreas. […] A main through-line in the various guidelines is the importance of determining the type of cyst and risks for neoplasia. […] High-risk features of IPMNs include jaundice due to cyst-related biliary compression, pancreatic duct of 10 mm, mural nodule of 5 mm or solid mass, and/or cytology with high-grade dysplasia or cancer. […] Worrisome features for pancreatic neoplasia include acute pancreatitis, mural nodule of 5 mm, main pancreatic duct size of 5-9 mm, abrupt pancreatic duct caliber changes, increased serum level of CA 19-9, cyst 3 cm, or rapid increases in size (2.5-5 mm/year).

• #31 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. […] While benign cysts usually dont require further treatment, cancerous or precancerous cysts require ongoing surveillance or surgery. […] 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. […] In an article for Translational Cancer Research, Nathan Berger, MD, a member of the GI Cancer Genetics Program at the Case Comprehensive Cancer Center and Professor of Medicine, Biochemistry, Oncology, Genetics and Genome Sciences at the School of Medicine, noted that a Mayo Clinic study that found the five-year risk for developing pancreatic cancer was 49.7 percent in high-risk groups (obstructive jaundice, cystic lesions in pancreas head, solid components within cysts, thickened or enhancing cyst wall, or main duct dilatation 10 mm), while the risk for those with worrisome features (pancreatitis without other causes, cysts 3 cm, thickened walls, main duct dilatation 59 mm, mural nodules, lymphadenopathy, abrupt change in duct dilatation with distal pancreatic atrophy) was 5.1 percent.

• #32 Pancreatic Cyst Surveillance Protocol | Pancreatic Cancer Prevention | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pancreatic-cancer-prevention/pancreatic-cyst-surveillance-protocol/

  In most cases, surveillance will be recommended, and our multidisciplinary team will recommend the appropriate timeline for follow-up imaging and visits. […] Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as: […] All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case. […] The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk. […] Patients who fall into the low-risk category will undergo less frequent surveillance. […] Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.

• #33 Pancreatic Cyst Surveillance Program | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/pancreatic-cysts/treatment/pancreatic-cyst-surveillance

  Memorial Sloan Kettering (MSK) has a special program for people who have benign (not cancer) pancreatic cysts or precancerous lesions. Our Pancreatic Cyst Surveillance Program is among the largest of its kind in the United States. […] For almost 30 years, our experts have safely monitored more than 5,000 people with pancreatic cysts. […] In general, surveillance (monitoring) is the best option when surgery is riskier than the chance a cyst can harm you. […] We may recommend ongoing surveillance if you had surgery to remove a cyst that can come back. […] When you join MSKs Pancreatic Cyst Surveillance Program, you will have routine diagnostic tests that screen for problems. Most people in the program visit MSK every 6 months to 1 year for screening. […] Surveillance (monitoring) is safe and works well. We recommend surgery to remove pancreatic cysts only when theres a high risk its cancer, or will become cancer soon. […] We closely monitor IPMNs for any signs of cancer.

• #34 Pancreatic Cyst Surveillance Protocol | Pancreatic Cancer Prevention | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pancreatic-cancer-prevention/pancreatic-cyst-surveillance-protocol/

  In most cases, surveillance will be recommended, and our multidisciplinary team will recommend the appropriate timeline for follow-up imaging and visits. […] Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as: […] All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case. […] The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk. […] Patients who fall into the low-risk category will undergo less frequent surveillance. […] Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.

• #35 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pancreatic cysts (PC) are an increasingly common problem facing general gastroenterologists and generalists. They can be divided into 3 groups. First, those that have no risk of developing into pancreatic cancer, such as a pseudocyst or serous cystadenomas (SCAs). Second, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), which are precursor lesions to high-grade dysplasia and pancreatic cancer. Third, solid cancers of the pancreas, such as neuroendocrine tumors and pancreatic adenocarcinomas, which have undergone cystic degeneration. […] The American College of Gastroenterology (ACG), the American Gastrointestinal Association (AGA), European, American College of Radiology (ACR), and International Association of Pancreatology (IAP) group (also known as the Fukuoka) have developed PC guidelines.

• #36 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pseudocysts and serous cysts require no surveillance. Cyst caused by cystic degeneration of a pancreatic adenocarcinoma or neuroendocrine tumor should be referred for consideration of surgical resection. Only patients with an IPMN or MCN require surveillance. […] The guidelines vary on their recommendations with recommended surveillance intervals of between 6 and 24 months for patients with PCs with no concerning features. […] All the guidelines recommend that patients are referred to a multidisciplinary group for further evaluation or undergo surgical resection if there is a significant concern for pancreatic cancer. […] Patients with SCA, pseudocysts, or MCNs without invasive cancer require no surveillance after resection. The ACG, AGA, IAP, and European guidelines recommend surveillance of the remnant pancreas in patients with IPMNs.

• #37 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pseudocysts and serous cysts require no surveillance. Cyst caused by cystic degeneration of a pancreatic adenocarcinoma or neuroendocrine tumor should be referred for consideration of surgical resection. Only patients with an IPMN or MCN require surveillance. […] The guidelines vary on their recommendations with recommended surveillance intervals of between 6 and 24 months for patients with PCs with no concerning features. […] All the guidelines recommend that patients are referred to a multidisciplinary group for further evaluation or undergo surgical resection if there is a significant concern for pancreatic cancer. […] Patients with SCA, pseudocysts, or MCNs without invasive cancer require no surveillance after resection. The ACG, AGA, IAP, and European guidelines recommend surveillance of the remnant pancreas in patients with IPMNs.

• #38 Study Tests Guidelines for Monitoring Pancreatic Cysts

  https://www.onclive.com/view/study-tests-guidelines-for-monitoring-pancreatic-cysts

  Investigators are seeking to determine the optimal protocol for monitoring patients with pancreatic cysts to better identify neoplasms that are more likely to become malignant. […] Pancreatic cysts are very common findings in otherwise healthy patients as they get older, said David S. Weinberg, MD, MSc, principal investigator on the study. […] Patients with pancreatic cysts are managed with surveillance protocols, but at present there is no consensus on which protocol is the most clinically effective or which is the best use of resources. […] The 2 major strategies for the management of pancreatic cysts are detailed in the Fukuoka guideline, published initially in 2012 and revised in 2017, and the American Gastroenterological Association (AGA) recommendations, published in 2015. […] Both guidelines are clinically accepted, and insurance companies cover the costs of monitoring, Weinberg said.

• #39 Study Tests Guidelines for Monitoring Pancreatic Cysts

  https://www.onclive.com/view/study-tests-guidelines-for-monitoring-pancreatic-cysts

  The Fukuoka surveillance guidelines recommend an MRI or a CT scan at 6 months for cysts less than 1 cm and then every 2 years if there is no change. […] For cysts that are 1 cm to 2 cm, MRI or CT should be conducted annually, then every 2 years if the cyst is stable. […] For cysts 2 cm to 3 cm, an endoscopic ultrasound (EUS) is recommended at months 3 to 6; after that, the EUS and MRI can alternate, and the time between scans can be lengthened. […] For cysts greater than 3 cm, the guideline recommends alternating between MRI and EUS every 3 to 6 months. […] The AGA guideline recommends MRI in the first year, then every 2 years, for cysts less than 3 cm, with surveillance if there is no significant change in size or characteristics. […] For cysts with higher-risk features, including size greater than 3 cm, the guideline recommends examination with an EUS with fine-needle aspiration (FNA).

• #40 Study Tests Guidelines for Monitoring Pancreatic Cysts

  https://www.onclive.com/view/study-tests-guidelines-for-monitoring-pancreatic-cysts

  The Fukuoka surveillance guidelines recommend an MRI or a CT scan at 6 months for cysts less than 1 cm and then every 2 years if there is no change. […] For cysts that are 1 cm to 2 cm, MRI or CT should be conducted annually, then every 2 years if the cyst is stable. […] For cysts 2 cm to 3 cm, an endoscopic ultrasound (EUS) is recommended at months 3 to 6; after that, the EUS and MRI can alternate, and the time between scans can be lengthened. […] For cysts greater than 3 cm, the guideline recommends alternating between MRI and EUS every 3 to 6 months. […] The AGA guideline recommends MRI in the first year, then every 2 years, for cysts less than 3 cm, with surveillance if there is no significant change in size or characteristics. […] For cysts with higher-risk features, including size greater than 3 cm, the guideline recommends examination with an EUS with fine-needle aspiration (FNA).

• #41 Pancreatic Cysts Are Monitored in New Trial Aimed at Reducing Cancer Risk Through Targeted Screening | Division of Cancer Prevention

  https://prevention.cancer.gov/news-and-events/blog/pancreatic-cysts-are-monitored-new-trial-aimed-reducing-cancer-risk-through

  In a new NCI-sponsored study now recruiting participants, investigators will evaluate two different screening strategies for non-cancerous pancreatic cysts to determine which works best at detecting early malignancy. […] Even though few of these sac-like structures are likely to develop into pancreatic cancer, researchers said, accurately predicting which cysts pose the highest cancer risk is essential to improving prevention and early detection. […] The study EA2185 is comparing the two standard follow-up screening schedules currently in use by physicians. […] Pancreatic cancers account for 3% of all cancers in the United States and 7% of all cancer deaths. […] If you take all comers with pancreatic cysts, the risk they will turn cancerous is about 0.25% per year, Dr. Weinberg said.

• #42 EA2185 Pancreatic Cyst Surveillance Study: Amendment #2 Highlights – News from the ECOG-ACRIN Cancer Research Group

  https://blog-ecog-acrin.org/ea2185-pancreatic-cyst-surveillance-study-amendment-2-highlights/

  Pancreatic cysts are a common and often incidental finding on abdominal imaging. Te cysts are important to monitor because a minority of them will transform into pancreatic cancer over time. The optimal long-term management strategy for these cysts is unknown, posing a challenge for patients and their physicians. Longitudinal surveillance of cysts is based on cross-sectional imaging and sometimes endoscopic ultrasound (EUS). The two primary surveillance strategies in clinical practice are the 2012 Fukuoka guidelines (from the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan), and the 2015 American Gastroenterological Association (AGA) evidence-based guidelines. They vary in their recommendations about how often CT or MRI scans should be obtained, the indications for EUS, and the role of surgery.

• #43 Comparing the Clinical Impact of Pancreatic Cyst Surveillance Programs and Associated Biomarkers – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCT04239573

  The purpose of this study is to compare two approaches for monitoring pancreatic cysts as well as to identify associated biomarkers. The study doctors want to compare more frequent monitoring versus less frequent monitoring as well as identify biomarkers which may improve risk detection of transformation to pancreatic cancer. The study doctors want to learn which monitoring method and which biomarkers lead to better outcomes for patients. […] Patients undergo magnetic resonance imaging (MRI) or CT scans as well as blood sample collection throughout the trial. Patients undergo endoscopic ultrasound (EUS), fine needle aspiration (FNA), biopsy and surgery as clinically indicated. […] Patients are followed up every 6 months or yearly for 5 years from the date of registration. […] This is an observational study. Patients are randomized to 1 of 2 arms.

• #44 Pancreatic cysts are common and usually benign—except those that turn deadly An NCI trial compares surveillance regimens – The Cancer Letter

  https://cancerletter.com/the-cancer-letter/20211008_1/

  Stopping short of providing an answer on surgical intervention, the trial compares two commonly used regimens for monitoring pancreatic cysts, measuring impact on a composite of “unfavorable” outcomes, which include any pancreatic cancer without surgery and diagnosis of unresectable pancreatic cancer at surgery. […] The trial compares two guidelines for surveillance of these cysts. One set of guidelines in the trial is similar to the Fukuoka regimen and the lower-intensity guidelines similar to those promulgated by the American Gastroenterological Association. […] The ECOG-ACRIN study is asking a critical question to help the field understand how to manage individuals with pancreatic cysts, because of the dismal survival rates of pancreatic cancer, detection at the earliest indication of progression to malignancy can greatly increase the patient’s likelihood of a good outcome.

• #45 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  The ACG and ACR guidelines address whether surveillance should stop at a certain age. The ACG recommends reviewing the utility of ongoing surveillance at age 75, with an individualized approach for those aged 76-85 including an informed discussion about surgery, whereas the ACR recommends against continuing ongoing surveillance in individuals aged 80. […] The AGA and ACR recommend stopping surveillance if there is no change in the cysts after 5-3 or 10-6 years, respectively. In contrast the ACG, European, and ICC recommend ongoing surveillance. […] PCs are an extremely common finding on abdominal imaging, and rarely lead to pancreatic cancer. CT, magnetic resonance imaging, and EUS are useful to identify the type of PC, and detecting high-grade dysplasia or cancer in IPMN and MCNs.

• #46 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  The ACG and ACR guidelines address whether surveillance should stop at a certain age. The ACG recommends reviewing the utility of ongoing surveillance at age 75, with an individualized approach for those aged 76-85 including an informed discussion about surgery, whereas the ACR recommends against continuing ongoing surveillance in individuals aged 80. […] The AGA and ACR recommend stopping surveillance if there is no change in the cysts after 5-3 or 10-6 years, respectively. In contrast the ACG, European, and ICC recommend ongoing surveillance. […] PCs are an extremely common finding on abdominal imaging, and rarely lead to pancreatic cancer. CT, magnetic resonance imaging, and EUS are useful to identify the type of PC, and detecting high-grade dysplasia or cancer in IPMN and MCNs.

• #47 Optimal Follow-up of Incidental Pancreatic Cystic Lesions without Worrisome Features: The Follow-up Strategy Is Still Evolving

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=2172&vmd=Full

  The study showed that there was still a chance for malignancy to progress after 5 years of follow-up, and the majority of pancreatic cystic lesions without the development of worrisome features (WF) or high-risk stigmata (HRS) within 10 years had a good clinical prognosis even after 10 years. Optimal surveillance duration is an area of significant controversy. The American Gastroenterological Association proposes stopping surveillance after 5 years, if there are no changes in the cysts for 5 years after diagnosis. In contrast, the American College of Gastroenterology, European Study Group, and International Association of Pancreatology recommend ongoing surveillance even after 5 years. Although current guidelines have no consistency regarding follow-up intervals and the duration of surveillance, there is growing evidence to suggest that pancreatic cystic lesions may have a considerable risk of developing cancer, even after 5 years.

• #48 How many pancreatic cysts are out there and how to best manage them? – Ciofoaia – Translational Cancer Research

  https://tcr.amegroups.org/article/view/20303/15984

  The AGA guidelines recommend MRI surveillance after 1 year and then every 2 years for a total of 5 years for patients with pancreatic cysts without high risk features, with EUS-FNA pursued if one high risk feature is present and surgery recommended if there are two high risk features. […] Many studies show that stopping surveillance after 5 years (as recommended by AGA) would miss some cysts that may progress to cancer. […] The recommendation to expand the surveillance period to 10 years is based on the finding that even after 5 years of stability pancreatic cysts can still increase in size. […] The international Fukuoka guideline risk stratify pancreatic cysts based on high-risk stigmata and worrisome features. […] Current research is focusing on risk stratification of the pancreatic cystic lesions, molecular and genetic markers of cyst and the role of integrated molecular pathology.

• #49 Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines

  https://www.mdpi.com/2077-0383/12/12/4020

  Ensuring the proper management of pancreatic neoplastic epithelial cysts is consistent with the ACG, AGA, and EU guidelines. […] For patients over 75 years old, surveillance should be individualized based on life expectancy and comorbidities. […] Surveillance should be lifelong according to EU, Fukuoka and ACG guidelines, except for stable cysts after 5 years and if patients are no longer surgical candidates. […] The surveillance regime for cysts under 1 cm should be monitoring via MRI every 2 years, annual MRI for cysts measuring 1–2 cm, and MRI/EUS every 6–12 months for cysts measuring 2–3 cm. For cysts over 3 cm, EUS or MRCP are recommended every 6 months for 3 years and then yearly for 4 years. […] Despite these recommendations, there are many cases that present atypical findings, raising the question of whether EUS should become essential for the proper diagnosis and further management of pancreatic cysts.

• #50 European evidence-based guidelines on pancreatic cystic neoplasms | Gut

  https://gut.bmj.com/content/67/5/789

  Follow-up of BD-IPMN is required as progression of disease is expected in about 10-15% of patients during 3-5 years of follow-up. Surveillance should also include the entire pancreatic gland because of an increased risk of new-onset cancer. […] The risk of IPMN progression increases over the time, therefore patients affected by IPMN without indication for surgery should be followed up until they are no longer fit for surgery.

• #51 European evidence-based guidelines on pancreatic cystic neoplasms | Gut

  https://gut.bmj.com/content/67/5/789

  Pancreatic cystic neoplasms (PCN) are estimated to be present in 245% of the general population. PCN comprise a clinically challenging entity as their biological behaviour ranges from benign to malignant disease. Consequently, correct management of PCN may prevent progression to pancreatic cancer while minimising the need for lifelong screening and related costs. […] The European evidence-based guidelines on PCN aim to improve the diagnosis and management of all PCN, and identify areas that require further research. […] Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. […] Patients with PCN may require lifelong imaging follow-up. This is important, as studies have shown that repeated exposure to ionising radiation following CT increases the risk of malignancy.

• #52 Pancreatic Cyst Surveillance – Southern California Multi-Specialty Center

  https://scmsc.com/general-surgery/general-treatments/pancreatic-cyst-surveillance/

  When dealing with pancreatic cysts, it is important to assess the risk factors associated with developing pancreatic cancer. By identifying these high-risk features, healthcare professionals can develop a plan for closely monitoring patients who have been diagnosed with this condition. […] Recognizing and assessing any high risk features associated with pancreatic cysts is essential for effectively determining a suitable management strategy. […] Pancreatic cysts are a serious health concern, so it is important to recognize high risk features when evaluating patients. […] Pancreatic cyst surveillance necessitates the use of imaging techniques, such as CT scans, MRI with MRCP and endoscopic ultrasound (EUS), in order to observe any changes in size over time and detect potential signs of malignancy.

• #53 Diagnosis and Management of Pancreatic Cysts

  https://www.mdcalc.com/guidelines/10393/acg/diagnosis-management-pancreatic-cysts

  Cyst surveillance should be offered to surgically fit candidates with asymptomatic cysts that are presumed to be IPMNs or MCNs. […] Patients with IPMNs or MCNs with new-onset or worsening diabetes mellitus, or a rapid increase in cyst size (of 3 mm/year) during surveillance, may have an increased risk of malignancy, so should undergo a short-interval MRI or EUSFNA. […] MRCP is the preferred modality for pancreatic cyst surveillance, given the lack of radiation and improved delineation of the main pancreatic duct. […] In the absence of concerning features (Table 3), which warrant increased surveillance or referral for further evaluation, cyst size guides surveillance intervals for presumed IPMNs and MCNs (Figure 2). […] All surgically resected IPMN require postoperative surveillance.

• #54 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. […] 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. […] Many kinds of cysts can grow on the pancreas, some cancerous and some benign. […] Watchful waiting or treatment depends on the type of cyst you have, its size, its characteristics and whether it’s causing symptoms. […] Some types of pancreatic cysts require surgical removal because of the risk of cancer.

• #55 Updates in diagnosis and management of pancreatic cysts

  https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm

  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. […] The American Gastroenterological Association (AGA) technical review of incidental pancreatic cysts estimated incident risk of malignancy at 0.24% per year with a prevalent malignant risk of 0.25% at the time the cyst is identified. […] Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines. […] MRI pancreas with magnetic resonance cholangiopancreatography in 1.5 or 3 tesla should be performed. 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.

• #56 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  The most recent guideline for the management of pancreatic cyst was published in 2007 by Khalid and Brugge. […] In this guideline the authors advice to thoroughly evaluate each incidental pancreatic cyst since many cysts are premalignant (MCN and IPMN). […] The initial imaging test proposed is a contrast-enhanced triphasic multidetector CT scan, which may be followed by EUS-FNA in particular cases when FNA is needed for CEA level or to puncture a solid component. […] Resection is recommended in all MCNs and main-duct IPMNs. […] Firm recommendations for the management of branch-duct IPMNs are not provided. […] All pseudopapillary neoplasms should be considered for resection. […] No general guidelines are provided for the interval of follow up when surgery is not undertaken.

• #57 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  The most recent guideline for the management of pancreatic cyst was published in 2007 by Khalid and Brugge. […] In this guideline the authors advice to thoroughly evaluate each incidental pancreatic cyst since many cysts are premalignant (MCN and IPMN). […] The initial imaging test proposed is a contrast-enhanced triphasic multidetector CT scan, which may be followed by EUS-FNA in particular cases when FNA is needed for CEA level or to puncture a solid component. […] Resection is recommended in all MCNs and main-duct IPMNs. […] Firm recommendations for the management of branch-duct IPMNs are not provided. […] All pseudopapillary neoplasms should be considered for resection. […] No general guidelines are provided for the interval of follow up when surgery is not undertaken.

• #58 Pancreatic Cystic Lesions: A Case-Based Approach

  https://www.gastroendonews.com/Review-Articles/Article/10-24/pancreas-pancreatic-cysts-lesions-imaging/75191

  Pancreatic cystic lesions are being found more frequently on cross-sectional imaging studies. The incidence of pancreatic cystic lesions is increasing, partly due to the aging population, the increased use of cross-sectional imaging studies, and, perhaps, other reasons that are unclear. The prevalence of pancreatic cysts increases with age; it has an approximate overall incidence of 15% on MRI, with meta-analysis data showing this number increases from 9% in people aged 50 to 59 years to as high as 38% in those aged 80 years and older. […] High-resolution cross-sectional imaging in the form of CT or MRI allows for noninvasive assessment and characterization of these lesions, whereas endoscopic ultrasound (EUS) is more invasive but allows for the most sensitive assessment and diagnostic sampling.

• #59 Updates in diagnosis and management of pancreatic cysts

  https://www.wjgnet.com/1007-9327/full/v27/i34/5700.htm

  All pancreatic cyst guidelines agree that patients who are not surgically fit do not need ongoing surveillance. […] The multiple guidelines that have been proposed to assist clinicians with managing pancreatic cystic lesions share many commonalities although the AGA guideline is the significant outlier. […] Following radiologic imaging, the role of EUS in the diagnostic work-up of pancreatic cysts includes evaluating cysts that are indeterminate or have risk features, or if EUS may change management. […] Surgery should be considered for patients with cysts that are symptomatic, malignant, or at high-risk for malignancy. […] 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.

• #60 Study Tests Guidelines for Monitoring Pancreatic Cysts

  https://www.onclive.com/view/study-tests-guidelines-for-monitoring-pancreatic-cysts

  The Fukuoka surveillance guidelines recommend an MRI or a CT scan at 6 months for cysts less than 1 cm and then every 2 years if there is no change. […] For cysts that are 1 cm to 2 cm, MRI or CT should be conducted annually, then every 2 years if the cyst is stable. […] For cysts 2 cm to 3 cm, an endoscopic ultrasound (EUS) is recommended at months 3 to 6; after that, the EUS and MRI can alternate, and the time between scans can be lengthened. […] For cysts greater than 3 cm, the guideline recommends alternating between MRI and EUS every 3 to 6 months. […] The AGA guideline recommends MRI in the first year, then every 2 years, for cysts less than 3 cm, with surveillance if there is no significant change in size or characteristics. […] For cysts with higher-risk features, including size greater than 3 cm, the guideline recommends examination with an EUS with fine-needle aspiration (FNA).

• #61 Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3191780/

  The most recent guideline for the management of pancreatic cyst was published in 2007 by Khalid and Brugge. […] In this guideline the authors advice to thoroughly evaluate each incidental pancreatic cyst since many cysts are premalignant (MCN and IPMN). […] The initial imaging test proposed is a contrast-enhanced triphasic multidetector CT scan, which may be followed by EUS-FNA in particular cases when FNA is needed for CEA level or to puncture a solid component. […] Resection is recommended in all MCNs and main-duct IPMNs. […] Firm recommendations for the management of branch-duct IPMNs are not provided. […] All pseudopapillary neoplasms should be considered for resection. […] No general guidelines are provided for the interval of follow up when surgery is not undertaken.

• #62 13 Tips for Pancreatic Cyst Surveillance

  https://www.medscape.com/viewarticle/977133

  The ever-increasing use of radiographic imaging of the abdomen, in particular by CT and MRI, has led to a significant rise in the discovery of patients with pancreatic cysts. […] Over the past few years, guidelines on this topic have been published by the American Gastroenterological Association, the American College of Gastroenterology, the American College of Radiology, and the European Study Group on Cystic Tumours of the Pancreas. […] A main through-line in the various guidelines is the importance of determining the type of cyst and risks for neoplasia. […] High-risk features of IPMNs include jaundice due to cyst-related biliary compression, pancreatic duct of 10 mm, mural nodule of 5 mm or solid mass, and/or cytology with high-grade dysplasia or cancer. […] Worrisome features for pancreatic neoplasia include acute pancreatitis, mural nodule of 5 mm, main pancreatic duct size of 5-9 mm, abrupt pancreatic duct caliber changes, increased serum level of CA 19-9, cyst 3 cm, or rapid increases in size (2.5-5 mm/year).

• #63 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 Pancreatic Cyst Surveillance Program is one of the largest in the country. It monitors pancreatic cysts and has provided treatment more than 5,000 people. Each year, MSK sees more than 300 new patients who have a pancreas cyst. […] 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. Thats why we encourage people with cysts to join MSKs Pancreatic Cyst Surveillance Program. […] Our researchers are also exploring biomarkers, such as proteins and genes. They can help us know which cysts are benign (not cancer) or precancerous.

• #64 Pancreatic Cysts Are Monitored in New Trial Aimed at Reducing Cancer Risk Through Targeted Screening | Division of Cancer Prevention

  https://prevention.cancer.gov/news-and-events/blog/pancreatic-cysts-are-monitored-new-trial-aimed-reducing-cancer-risk-through

  Up to 7 million people over age 60 in the U.S. may develop a pancreatic cyst that is large enough to need imaging surveillance. […] The main difference between the two screening approaches, Dr. Weinberg said, lies in screening frequency, with the Fukuoka surveillance system having more frequent patient monitoring, while the AGA system calls for less frequent monitoring of patients pancreatic cysts. […] During the trial, doctors will recommend surgery to any participant in the study who develops presumed risk factors for a cancerous lesion. […] By far, were operating on more of these cysts than we need to, acknowledged Kevin Soares, M.D., a cancer surgeon at Memorial Sloan Kettering Cancer Center. […] At Memorial Sloan Kettering, patients diagnosed with pancreatic cysts undergo regular monitoring for rapid changes in size or other features, such as high-grade dysplasia, that might signal a developing cancer. […] Even in patients who have had cyst resection, the rest of the pancreas is still at risk (for cancer) going forward. […] For the new EA2185 screening study, an important secondary goal involves the collection and banking of blood, DNA from buccal (cheek) swabs and cyst fluid for future research.

• #65 Pancreatic Cyst Surveillance Program | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/pancreatic-cysts/treatment/pancreatic-cyst-surveillance

  Memorial Sloan Kettering (MSK) has a special program for people who have benign (not cancer) pancreatic cysts or precancerous lesions. Our Pancreatic Cyst Surveillance Program is among the largest of its kind in the United States. […] For almost 30 years, our experts have safely monitored more than 5,000 people with pancreatic cysts. […] In general, surveillance (monitoring) is the best option when surgery is riskier than the chance a cyst can harm you. […] We may recommend ongoing surveillance if you had surgery to remove a cyst that can come back. […] When you join MSKs Pancreatic Cyst Surveillance Program, you will have routine diagnostic tests that screen for problems. Most people in the program visit MSK every 6 months to 1 year for screening. […] Surveillance (monitoring) is safe and works well. We recommend surgery to remove pancreatic cysts only when theres a high risk its cancer, or will become cancer soon. […] We closely monitor IPMNs for any signs of cancer.

• #66 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 Pancreatic Cyst Surveillance Program is one of the largest in the country. It monitors pancreatic cysts and has provided treatment more than 5,000 people. Each year, MSK sees more than 300 new patients who have a pancreas cyst. […] 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. Thats why we encourage people with cysts to join MSKs Pancreatic Cyst Surveillance Program. […] Our researchers are also exploring biomarkers, such as proteins and genes. They can help us know which cysts are benign (not cancer) or precancerous.

• #67 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. […] The Children’s Hospital of New York has one of the largest pancreatic cyst surveillance clinics in the country, offering periodic monitoring of potentially precancerous cysts and minimally invasive treatment for cysts that cause pain and discomfort. […] Most pancreatic cysts are found accidently, and many will just need to be followed with repeat imaging at intervals determined by the cyst’s characteristics. […] If you have a pancreatic cyst or an intraductal papillary mucinous neoplasm that places you at increased risk of pancreatic cancer, we offer assessment, monitoring, and treatment through the Pancreatic Cyst Surveillance Programs at New York-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center. […] Our experts have superior knowledge and expertise in the diagnosis, treatment, and monitoring of pancreatic cysts. Through our surveillance programs, we take a full personal and family medical history and perform a comprehensive examination, imaging tests, and biopsies.

• #68 Pancreatic Cyst Surveillance Program | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/pancreatic-cysts/treatment/pancreatic-cyst-surveillance

  Memorial Sloan Kettering (MSK) has a special program for people who have benign (not cancer) pancreatic cysts or precancerous lesions. Our Pancreatic Cyst Surveillance Program is among the largest of its kind in the United States. […] For almost 30 years, our experts have safely monitored more than 5,000 people with pancreatic cysts. […] In general, surveillance (monitoring) is the best option when surgery is riskier than the chance a cyst can harm you. […] We may recommend ongoing surveillance if you had surgery to remove a cyst that can come back. […] When you join MSKs Pancreatic Cyst Surveillance Program, you will have routine diagnostic tests that screen for problems. Most people in the program visit MSK every 6 months to 1 year for screening. […] Surveillance (monitoring) is safe and works well. We recommend surgery to remove pancreatic cysts only when theres a high risk its cancer, or will become cancer soon. […] We closely monitor IPMNs for any signs of cancer.

• #69 Pancreatic Cyst Surveillance Program | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/pancreatic-cysts/treatment/pancreatic-cyst-surveillance

  Memorial Sloan Kettering (MSK) has a special program for people who have benign (not cancer) pancreatic cysts or precancerous lesions. Our Pancreatic Cyst Surveillance Program is among the largest of its kind in the United States. […] For almost 30 years, our experts have safely monitored more than 5,000 people with pancreatic cysts. […] In general, surveillance (monitoring) is the best option when surgery is riskier than the chance a cyst can harm you. […] We may recommend ongoing surveillance if you had surgery to remove a cyst that can come back. […] When you join MSKs Pancreatic Cyst Surveillance Program, you will have routine diagnostic tests that screen for problems. Most people in the program visit MSK every 6 months to 1 year for screening. […] Surveillance (monitoring) is safe and works well. We recommend surgery to remove pancreatic cysts only when theres a high risk its cancer, or will become cancer soon. […] We closely monitor IPMNs for any signs of cancer.

• #70 Pancreatic Cyst Surveillance Protocol | Pancreatic Cancer Prevention | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pancreatic-cancer-prevention/pancreatic-cyst-surveillance-protocol/

  In most cases, surveillance will be recommended, and our multidisciplinary team will recommend the appropriate timeline for follow-up imaging and visits. […] Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as: […] All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case. […] The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk. […] Patients who fall into the low-risk category will undergo less frequent surveillance. […] Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.

• #71 Pancreatic Cyst Surveillance Protocol | Pancreatic Cancer Prevention | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pancreatic-cancer-prevention/pancreatic-cyst-surveillance-protocol/

  In most cases, surveillance will be recommended, and our multidisciplinary team will recommend the appropriate timeline for follow-up imaging and visits. […] Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as: […] All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case. […] The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk. […] Patients who fall into the low-risk category will undergo less frequent surveillance. […] Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.

• #72 Pancreatic Cyst Surveillance Program

  https://www.rwjbh.org/cooperman-barnabas-medical-center/treatment-care/cancer/types-of-cancer/gastrointestinal-cancer/types-of-cancers-we-treat/pancreatic-cancer/pancreatic-cyst-surveillance-program/

  As a high-volume pancreatic cancer center, Cooperman Barnabas Medical Center partnered with Eon, a health care technology company, to create a first of its kind digital platform to identify, track, follow and monitor patients with pancreatic cysts. This program uses a new cloud-based system that automatically highlights patients when incidental scans, such as an MRI, CT scan or ultrasound, discover pancreatic cysts, so at-risk people can be contacted for potential follow-up. […] Patients who elect to enroll in The Pancreatic Cyst Surveillance Program at Cooperman Barnabas are followed by a pancreatic expert who will stratify and assess the risk of the cyst becoming cancerous. […] Around 15 percent of Americans are walking around with a pancreatic cyst. Of those, the risk of the cyst becoming cancerous can be as high as 60 percent and as low as 2 percent. Some cysts dont require immediate surgery but should be monitored regularly for particular changes that may suggest an increased risk of malignancy. […] This program helps determine the appropriate time to operate on patients, but also when to keep patients out of the operating room to prevent them from having unnecessary surgeries when the risk of complications is greater than the risk of cancer.

• #73 Pancreatic Cyst Surveillance Program

  https://www.rwjbh.org/cooperman-barnabas-medical-center/treatment-care/cancer/types-of-cancer/gastrointestinal-cancer/types-of-cancers-we-treat/pancreatic-cancer/pancreatic-cyst-surveillance-program/

  As a high-volume pancreatic cancer center, Cooperman Barnabas Medical Center partnered with Eon, a health care technology company, to create a first of its kind digital platform to identify, track, follow and monitor patients with pancreatic cysts. This program uses a new cloud-based system that automatically highlights patients when incidental scans, such as an MRI, CT scan or ultrasound, discover pancreatic cysts, so at-risk people can be contacted for potential follow-up. […] Patients who elect to enroll in The Pancreatic Cyst Surveillance Program at Cooperman Barnabas are followed by a pancreatic expert who will stratify and assess the risk of the cyst becoming cancerous. […] Around 15 percent of Americans are walking around with a pancreatic cyst. Of those, the risk of the cyst becoming cancerous can be as high as 60 percent and as low as 2 percent. Some cysts dont require immediate surgery but should be monitored regularly for particular changes that may suggest an increased risk of malignancy. […] This program helps determine the appropriate time to operate on patients, but also when to keep patients out of the operating room to prevent them from having unnecessary surgeries when the risk of complications is greater than the risk of cancer.

• #74 Similarities and differences in guidelines for the management of pancreatic cysts

  https://www.wjgnet.com/1007-9327/full/v26/i11/1128.htm

  Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer. […] The differentiation of mucinous and non-mucinous cysts is key in the effective management of pancreatic cysts. Thorough understanding of the absolute indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and the guidelines for surveillance are important in the diagnosis and treatment of pancreatic cysts. Patient-centered approach with a multidisciplinary team involving the surgeon, radiologist, pathologist, oncologist, and advanced endoscopist improves the management of pancreatic cysts.

• #75

  https://link.springer.com/article/10.1007/s10620-021-07084-1

  There remains a lifelong risk from IPMNs as even after resection there is a 0 to 65% risk of recurrence depending on the grade of dysplasia of the resected IPMN. […] Therefore, postoperative surveillance is critical. […] In light of these studies, surveillance cannot end in all patients after 5 years, and whether there is a subset of patients in whom surveillance may be safely stopped requires further investigation. […] While no study has yet proved reduction in mortality with surveillance, the risk of malignancy cannot be ignored, and it is critical that shared decision-making with the patient is pursued when offering surveillance. […] More specifically, referral to a multidisciplinary pancreas group is recommended for cysts with any concerning features and when considering surgical resection as evaluation by such a center changed management in 30% of patients away from surgery and toward surveillance.

• #76 Pancreatic Cyst Surveillance Program

  https://www.rwjbh.org/cooperman-barnabas-medical-center/treatment-care/cancer/types-of-cancer/gastrointestinal-cancer/types-of-cancers-we-treat/pancreatic-cancer/pancreatic-cyst-surveillance-program/

  As a high-volume pancreatic cancer center, Cooperman Barnabas Medical Center partnered with Eon, a health care technology company, to create a first of its kind digital platform to identify, track, follow and monitor patients with pancreatic cysts. This program uses a new cloud-based system that automatically highlights patients when incidental scans, such as an MRI, CT scan or ultrasound, discover pancreatic cysts, so at-risk people can be contacted for potential follow-up. […] Patients who elect to enroll in The Pancreatic Cyst Surveillance Program at Cooperman Barnabas are followed by a pancreatic expert who will stratify and assess the risk of the cyst becoming cancerous. […] Around 15 percent of Americans are walking around with a pancreatic cyst. Of those, the risk of the cyst becoming cancerous can be as high as 60 percent and as low as 2 percent. Some cysts dont require immediate surgery but should be monitored regularly for particular changes that may suggest an increased risk of malignancy. […] This program helps determine the appropriate time to operate on patients, but also when to keep patients out of the operating room to prevent them from having unnecessary surgeries when the risk of complications is greater than the risk of cancer.

• #77 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pseudocysts and serous cysts require no surveillance. Cyst caused by cystic degeneration of a pancreatic adenocarcinoma or neuroendocrine tumor should be referred for consideration of surgical resection. Only patients with an IPMN or MCN require surveillance. […] The guidelines vary on their recommendations with recommended surveillance intervals of between 6 and 24 months for patients with PCs with no concerning features. […] All the guidelines recommend that patients are referred to a multidisciplinary group for further evaluation or undergo surgical resection if there is a significant concern for pancreatic cancer. […] Patients with SCA, pseudocysts, or MCNs without invasive cancer require no surveillance after resection. The ACG, AGA, IAP, and European guidelines recommend surveillance of the remnant pancreas in patients with IPMNs.

• #78 13 Tips for Pancreatic Cyst Surveillance

  https://www.medscape.com/viewarticle/977133

  The development of new-onset diabetes should warrant repeat imaging and shortened surveillance intervals. […] Patients with evidence of high-risk or worrisome features should be evaluated via endoscopic ultrasound with fine-needle aspiration. […] Surgical referral should be done for cysts 3 cm. […] No surveillance is recommended following resection (if done) for pseudocysts, serous cystadenomas, or mucinous cystic neoplasms. […] However, surveillance is recommended for patients with IPMN and a remnant pancreas. […] While surveillance can be stopped if patients are older than 75 years, the risks and benefits should be assessed and discussed with them. […] There are potential harms for invasive evaluation and significant costs related to the treatments for pancreatic cysts.

• #79 Pancreatic Cyst Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10548438/

  Pseudocysts and serous cysts require no surveillance. Cyst caused by cystic degeneration of a pancreatic adenocarcinoma or neuroendocrine tumor should be referred for consideration of surgical resection. Only patients with an IPMN or MCN require surveillance. […] The guidelines vary on their recommendations with recommended surveillance intervals of between 6 and 24 months for patients with PCs with no concerning features. […] All the guidelines recommend that patients are referred to a multidisciplinary group for further evaluation or undergo surgical resection if there is a significant concern for pancreatic cancer. […] Patients with SCA, pseudocysts, or MCNs without invasive cancer require no surveillance after resection. The ACG, AGA, IAP, and European guidelines recommend surveillance of the remnant pancreas in patients with IPMNs.

• #80

  https://link.springer.com/article/10.1007/s10620-021-07084-1

  There remains a lifelong risk from IPMNs as even after resection there is a 0 to 65% risk of recurrence depending on the grade of dysplasia of the resected IPMN. […] Therefore, postoperative surveillance is critical. […] In light of these studies, surveillance cannot end in all patients after 5 years, and whether there is a subset of patients in whom surveillance may be safely stopped requires further investigation. […] While no study has yet proved reduction in mortality with surveillance, the risk of malignancy cannot be ignored, and it is critical that shared decision-making with the patient is pursued when offering surveillance. […] More specifically, referral to a multidisciplinary pancreas group is recommended for cysts with any concerning features and when considering surgical resection as evaluation by such a center changed management in 30% of patients away from surgery and toward surveillance.

• #81 Pancreatic Cysts Are Monitored in New Trial Aimed at Reducing Cancer Risk Through Targeted Screening | Division of Cancer Prevention

  https://prevention.cancer.gov/news-and-events/blog/pancreatic-cysts-are-monitored-new-trial-aimed-reducing-cancer-risk-through

  Up to 7 million people over age 60 in the U.S. may develop a pancreatic cyst that is large enough to need imaging surveillance. […] The main difference between the two screening approaches, Dr. Weinberg said, lies in screening frequency, with the Fukuoka surveillance system having more frequent patient monitoring, while the AGA system calls for less frequent monitoring of patients pancreatic cysts. […] During the trial, doctors will recommend surgery to any participant in the study who develops presumed risk factors for a cancerous lesion. […] By far, were operating on more of these cysts than we need to, acknowledged Kevin Soares, M.D., a cancer surgeon at Memorial Sloan Kettering Cancer Center. […] At Memorial Sloan Kettering, patients diagnosed with pancreatic cysts undergo regular monitoring for rapid changes in size or other features, such as high-grade dysplasia, that might signal a developing cancer. […] Even in patients who have had cyst resection, the rest of the pancreas is still at risk (for cancer) going forward. […] For the new EA2185 screening study, an important secondary goal involves the collection and banking of blood, DNA from buccal (cheek) swabs and cyst fluid for future research.

• #82 Novel Insights into Postoperative Surveillance in Resected Pancreatic Cystic Neoplasms—A Review

  https://www.mdpi.com/2075-4418/14/10/1056

  The clinical impact of surveillance of the remnant pancreas after resection is not very well represented in the literature. […] The majority of recurrences occur in the first 3 years after surgery, when intensive surveillance is warranted, but they can also develop at a later time, supporting the need for long-term follow-up of these patients. […] There is no consensus on the surveillance modalities either—while biomarkers play a limited role, the main techniques are represented by cross-sectional imaging (CT/MRI) and EUS, with an additional contrast enhancement. […] The presence of HGD and the multifocality of cysts defines a high-risk group which might benefit from more intensive monitoring. […] The surveillance of resected PCLs is required because of the recurrence risk in the remnant pancreas, as well as systemic progression and the long-term morbidity represented by exocrine and endocrine insufficiency.

• #83 Novel Insights into Postoperative Surveillance in Resected Pancreatic Cystic Neoplasms—A Review

  https://www.mdpi.com/2075-4418/14/10/1056

  The clinical impact of surveillance of the remnant pancreas after resection is not very well represented in the literature. […] The majority of recurrences occur in the first 3 years after surgery, when intensive surveillance is warranted, but they can also develop at a later time, supporting the need for long-term follow-up of these patients. […] There is no consensus on the surveillance modalities either—while biomarkers play a limited role, the main techniques are represented by cross-sectional imaging (CT/MRI) and EUS, with an additional contrast enhancement. […] The presence of HGD and the multifocality of cysts defines a high-risk group which might benefit from more intensive monitoring. […] The surveillance of resected PCLs is required because of the recurrence risk in the remnant pancreas, as well as systemic progression and the long-term morbidity represented by exocrine and endocrine insufficiency.

• #84 Pancreatic Cyst Surveillance Patterns Do Not Frequently Adhere to Guidelines – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/pancreatic-disorders/pancreatic-cyst-surveillance-patterns-do-not-frequently-adhere-to-guidelines/

  Most patients diagnosed with incidental pancreatic cysts receive no follow-up care despite multiple published guidelines recommending surveillance. […] The investigators of this retrospective cohort study sought to determine surveillance patterns of incidental pancreatic cysts, predictors of receiving surveillance, and guidelines regarding surveillance adherence. […] Of 100 participants eligible for surveillance, 53 received no follow-up care. […] Researchers of the study concluded that overall adherence to major published guidelines on pancreatic cyst surveillance was poor; however, radiology reports had a strong impact on surveillance whether they included the pancreatic cyst in the conclusion or specifically recommended follow-up. Incorporating standardized guidelines into radiology reports may improve pancreatic cyst care.

• #85 Pancreatic Cyst Surveillance Patterns Do Not Frequently Adhere to Guidelines – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/pancreatic-disorders/pancreatic-cyst-surveillance-patterns-do-not-frequently-adhere-to-guidelines/

  Most patients diagnosed with incidental pancreatic cysts receive no follow-up care despite multiple published guidelines recommending surveillance. […] The investigators of this retrospective cohort study sought to determine surveillance patterns of incidental pancreatic cysts, predictors of receiving surveillance, and guidelines regarding surveillance adherence. […] Of 100 participants eligible for surveillance, 53 received no follow-up care. […] Researchers of the study concluded that overall adherence to major published guidelines on pancreatic cyst surveillance was poor; however, radiology reports had a strong impact on surveillance whether they included the pancreatic cyst in the conclusion or specifically recommended follow-up. Incorporating standardized guidelines into radiology reports may improve pancreatic cyst care.

• #86

  https://journals.lww.com/ajg/fulltext/2021/10001/s128_disparities_in_referral_and_surveillance.128.aspx

  Pancreatic cystic lesions (PCLs) are often found incidentally on cross-sectional imaging. PCLs that have malignant potential, should undergo appropriate guideline-based surveillance. The rate and pattern of surveillance and referral of newly identified incidental PCLs on imaging obtained in the outpatient and emergency department (ED) setting is unknown. This study aimed to analyze surveillance and referral patterns of new incidental PCLs. […] Over the entire cohort, 36.7% of PCLs were not appropriately referred for expert consultation or surveillance. […] In the ED and outpatient setting, incidental new PCLs on cross-sectional imaging studies are referred for surveillance or expert consultation at suboptimal rates. Because the prevalence of PCLs is high, these insufficiencies could result in missed opportunities to prevent malignant transformation of PCLs, or to resect early cancers.

• #87 Pancreatic Cyst Surveillance Patterns Do Not Frequently Adhere to Guidelines – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/pancreatic-disorders/pancreatic-cyst-surveillance-patterns-do-not-frequently-adhere-to-guidelines/

  Most patients diagnosed with incidental pancreatic cysts receive no follow-up care despite multiple published guidelines recommending surveillance. […] The investigators of this retrospective cohort study sought to determine surveillance patterns of incidental pancreatic cysts, predictors of receiving surveillance, and guidelines regarding surveillance adherence. […] Of 100 participants eligible for surveillance, 53 received no follow-up care. […] Researchers of the study concluded that overall adherence to major published guidelines on pancreatic cyst surveillance was poor; however, radiology reports had a strong impact on surveillance whether they included the pancreatic cyst in the conclusion or specifically recommended follow-up. Incorporating standardized guidelines into radiology reports may improve pancreatic cyst care.

• #88 Advancing Pancreatic Cyst Surveillance and Care Pathways Via AI Software

  https://www.cancernetwork.com/view/advancing-pancreatic-cyst-surveillance-and-care-pathways-via-ai-software

  A computational linguistic model specific to the pancreas may help ensure that those with pancreatic cysts receive evidence-based surveillance and, if necessary, undergo adequate preventive care for suspected pancreatic cancer, according to Russell C. Langan, MD, FACS, FSSO. […] Compared with prior methods of cyst surveillance, Langan highlighted how this linguistics model may help transition patients to cancer care pathways more quickly while mitigating racial and ethnic disparities that may interfere with the natural delivery of treatment. […] These patients deserve lifelong surveillance when the cysts are mucinous and most of the surveillance programs, in my opinion, were antiquated. […] I helped Eon Health build a computation linguistics model thats specific to the pancreas to: improve the quality for a patient population that is living at risk for the development of pancreatic cancer, to ensure that they receive evidence- and guideline-based surveillance, and receive the appropriate intervention to, at times, prevent the development of pancreatic cancer.

• #89 Advancing Pancreatic Cyst Surveillance and Care Pathways Via AI Software

  https://www.cancernetwork.com/view/advancing-pancreatic-cyst-surveillance-and-care-pathways-via-ai-software

  A computational linguistic model specific to the pancreas may help ensure that those with pancreatic cysts receive evidence-based surveillance and, if necessary, undergo adequate preventive care for suspected pancreatic cancer, according to Russell C. Langan, MD, FACS, FSSO. […] Compared with prior methods of cyst surveillance, Langan highlighted how this linguistics model may help transition patients to cancer care pathways more quickly while mitigating racial and ethnic disparities that may interfere with the natural delivery of treatment. […] These patients deserve lifelong surveillance when the cysts are mucinous and most of the surveillance programs, in my opinion, were antiquated. […] I helped Eon Health build a computation linguistics model thats specific to the pancreas to: improve the quality for a patient population that is living at risk for the development of pancreatic cancer, to ensure that they receive evidence- and guideline-based surveillance, and receive the appropriate intervention to, at times, prevent the development of pancreatic cancer.

• #90 How many pancreatic cysts are out there and how to best manage them? – Ciofoaia – Translational Cancer Research

  https://tcr.amegroups.org/article/view/20303/15984

  The AGA guidelines recommend MRI surveillance after 1 year and then every 2 years for a total of 5 years for patients with pancreatic cysts without high risk features, with EUS-FNA pursued if one high risk feature is present and surgery recommended if there are two high risk features. […] Many studies show that stopping surveillance after 5 years (as recommended by AGA) would miss some cysts that may progress to cancer. […] The recommendation to expand the surveillance period to 10 years is based on the finding that even after 5 years of stability pancreatic cysts can still increase in size. […] The international Fukuoka guideline risk stratify pancreatic cysts based on high-risk stigmata and worrisome features. […] Current research is focusing on risk stratification of the pancreatic cystic lesions, molecular and genetic markers of cyst and the role of integrated molecular pathology.

• #91 Optimal Follow-up of Incidental Pancreatic Cystic Lesions without Worrisome Features: The Follow-up Strategy Is Still Evolving

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=2172&vmd=Full

  The findings of this study support the need for ongoing surveillance beyond 5 years for patients with pancreatic cystic lesions. However, it is difficult to draw definite conclusions from this study because not only the total number of enrolled patients (n=227) but also the number of patients with pancreatic cancer (n=4) was small. From a biological perspective, the risk of pancreatic cancer is anticipated to increase over time, not decrease. […] At this time, there is not enough evidence to justify continuing surveillance for all incidental pancreatic cysts after 5 years according to the findings of this study. Equally, there are not enough data to support stopping surveillance universally after 5 years of stability based on the American Gastroenterological Association guidelines. The era of precision medicine can give a possibility that a combination of patient factors (age and comorbidity), cyst factors (histology subtype, presence of WF/HRS, cyst size), and more precise pancreatic cyst fluid biomarkers, will result in a more detailed and well-informed approach for stopping or continuing incidental pancreatic cysts surveillance.

• #92 Study Tests Guidelines for Monitoring Pancreatic Cysts

  https://www.onclive.com/view/study-tests-guidelines-for-monitoring-pancreatic-cysts

  The primary end point of the study is a comparison of unfavorable outcomes within each arm. […] The study, which is scheduled to last for 8 years, aims to enroll patients in 150 sites across the United States. […] The hope, Weinberg said, is that in addition to reliably identifying the most clinically effective surveillance strategy, investigators can identify better ways to determine which cysts could become cancer.

• #93 New trial aims to settle debate on the intensity of pancreatic cyst surveillance | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2020/10/new-trial-aims-to-settle-debate-on-the-intensity-of-pancreatic-cyst-surveillance/

  Given the clinical equipoise and lack of a prospectively validated cyst surveillance strategy, researchers have developed the ECOG-ACRIN 2185: Comparing the Clinical Impact of Pancreatic Cyst Surveillance Programs Trial (NCT04239573). In this pragmatic trial, 4,606 patients meeting inclusion criteria will be randomized to either a low-intensity or high-intensity surveillance strategy based on the Sendai/Fukuoka and AGA guidelines, respectively. […] Important secondary endpoints will examine all cause pancreatic cancer incidence and mortality, surgical morbidity, resource utilization, and patient-reported outcomes (quality of life, cancer risk perception, and anxiety). The study protocol also includes the collection and banking of radiographic images and tissue and fluid specimens (serum, cyst, urine) at baseline and during the surveillance period for patients who consent to this aspect. […] Patients will be followed for five years after enrollment.

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