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The Incidental Pancreatic Cyst: When to Worry About Cancer

  • Danielle E. Kruse (Department of Radiology, Duke Health) ;
  • Erik K. Paulson (Department of Radiology, Duke Health)
  • Received : 2024.01.23
  • Accepted : 2024.04.02
  • Published : 2024.06.01

Abstract

Incidental pancreatic cystic lesions are a common challenge encountered by diagnostic radiologists. Specifically, given the prevalence of benign pancreatic cystic lesions, determining when to recommend aggressive actions such as surgical resection or endoscopic ultrasound with sampling is difficult. In this article, we review the common types of cystic pancreatic lesions including serous cystadenoma, intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm with imaging examples of each. We also discuss high-risk or worrisome imaging features that warrant a referral to a surgeon or endoscopist and provid several examples of these features. These imaging features adhere to the latest guidelines from the International Consensus Guidelines, American Gastroenterological Association (2015), American College of Gastroenterology (2018), American College of Radiology (2010, 2017), and European Guidelines (2013, 2018). Our focused article addresses the imaging dilemma of managing incidental cystic pancreatic lesions, weighing the options between imaging follow-up and aggressive interventions.

Keywords

References

  1. Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol 2018;113:464-479
  2. Luk L, Hecht EM, Kang S, Bhosale PR, Francis IR, Gandhi N, et al. Society of Abdominal Radiology disease focused panel survey on clinical utilization of incidental pancreatic cyst management recommendations and template reporting. J Am Coll Radiol 2021;18:1324-1331
  3. Brook OR, Beddy P, Pahade J, Couto C, Brennan I, Patel P, et al. Delayed growth in incidental pancreatic cysts: are the current American College of Radiology recommendations for follow-up appropriate? Radiology 2016;278:752-761
  4. Buerlein RCD, Shami VM. Management of pancreatic cysts and guidelines: what the gastroenterologist needs to know. Ther Adv Gastrointest Endosc 2021;14:26317745211045769
  5. Sahani DV, Kambadakone A, Macari M, Takahashi N, Chari S, Fernandez-del Castillo C. Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 2013;200:343-354 
  6. Yamaguchi K, Ohuchida J, Ohtsuka T, Nakano K, Tanaka M. Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2002;2:484-490
  7. Freeny PC, Saunders MD. Moving beyond morphology: new insights into the characterization and management of cystic pancreatic lesions. Radiology 2014;272:345-363
  8. Federle, MP. Diagnostic imaging: abdomen. 2nd ed. Salt Lake: Amirsys, 2010:44-58
  9. Ingkakul T, Warshaw AL, Fernandez-Del Castillo C. Epidemiology of intraductal papillary mucinous neoplasms of the pancreas: sex differences between 3 geographic regions. Pancreas 2011;40:779-780
  10. Weaver DT, Lietz AP, Mercaldo SF, Peters MLB, Hur C, Kong CY, et al. Testing for verification bias in reported malignancy risks for side-branch intraductal papillary mucinous neoplasms: a simulation modeling approach. AJR Am J Roentgenol 2019;212:596-601
  11. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17-32
  12. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738-753
  13. Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, Hijioka S, Jang JY, Lennon AM, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024;24:255-270
  14. Vege SS, Ziring B, Jain R, Moayyedi P. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:819-822
  15. Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, et al. Management of incidental pancreatic cysts: a white paper of the ACR incidental findings committee. J Am Coll Radiol 2017;14:911-923
  16. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789-804
  17. Kwong WT, Hunt GC, Fehmi SM, Honerkamp-Smith G, Xu R, Lawson RD, et al. Low rates of malignancy and mortality in asymptomatic patients with suspected neoplastic pancreatic cysts beyond 5 years of surveillance. Clin Gastroenterol Hepatol 2016;14:865-871
  18. Singhi AD, McGrath K, Brand RE, Khalid A, Zeh HJ, Chennat JS, et al. Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut 2018;67:2131-2141
  19. Rift CV, Melchior LC, Scheie D, Hansen CP, Lund EL, Hasselby JP. Molecular heterogeneity of pancreatic intraductal papillary mucinous neoplasms and implications for novel endoscopic tissue sampling strategies. J Clin Pathol 2022;75:681-686