Management of pancreatic cysts and guidelines: what the gastroenterologist needs to know

The prevalence of pancreatic cysts has increased significantly over the last decade, partly secondary to increased quality and frequency of cross-sectional imaging. While the majority never progress to cancer, a small number will and need to be followed. The management of pancreatic cysts can be both confusing and intimidating due to the multiple guidelines with varying recommendations. Despite the differences in the specifics of the guidelines, they all agree on several high-risk features that should get the attention of any clinician when assessing a pancreatic cyst: presence of a mural nodule or solid component, dilation of the main pancreatic duct (or presence of main duct intraductal papillary mucinous neoplasm), pancreatic cyst size ⩾3–4 cm, or positive cytology on pancreatic cyst fluid aspiration. Other important criteria to consider include rapid cyst growth (⩾5 mm/year), elevated serum carbohydrate antigen 19-9 levels, new-onset diabetes mellitus, or acute pancreatitis thought to be related to the cystic lesion.

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Management of Cystic Neoplasms of the Pancreas

10.2310/7800.16075 ◽

2018 ◽

Author(s):

Victoria R Rendell ◽

Walker A Julliard ◽

Adam M Awe ◽

Daniel E Abbott ◽

Emily R Winslow ◽

...

Keyword(s):

Pancreatic Cyst ◽

Cystic Neoplasm ◽

Pancreatic Cysts ◽

Multidisciplinary Teams ◽

Pancreatic Cystic Neoplasm ◽

Cross Sectional ◽

Management Guidelines ◽

Imaging Characteristics ◽

Cross Sectional Imaging ◽

Sectional Imaging

The diagnosis of pancreatic cystic lesions is increasingly common. The majority of pancreatic cysts are now diagnosed incidentally on cross-sectional imaging. Lack of clear evidence-based guidelines and overall poor understanding of the natural history of pancreatic cysts contribute to complexity of managing patients with pancreatic cysts. Pancreatic cystic neoplasm types differ in their presentation, histologic features, imaging characteristics, and predisposition to develop invasive malignancy. The diagnostic strategies to determine cyst type and presence of malignancy—cross-sectional imaging, endoscopic ultrasonography, and analyses of pancreatic cyst fluid aspirates—have improved over time. However, accurate characterization of cysts remains challenging. Several large groups, including the American College of Radiology, the American Gastroenterological Association, the European Study Group on Cystic Tumours of the Pancreas, and the International Association of Pancreatology, have released cyst management guidelines or recommendations that have important differences. In this review, we provide an overview of the most common pancreatic cystic neoplasm, evaluate recent advancements in diagnostic techniques, and compare current management guidelines. This review contains 7 figures, 5 tables, and 77 references. Key Words: intraductal papillary mucinous neoplasm, management guidelines, multidisciplinary teams, mucinous cystic neoplasm, pancreatic cyst, pancreatic cystic neoplasm, serous cystadenoma, solid pseudopapillary neoplasm, surgical oncology

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Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

The Surgery Journal ◽

10.1055/s-0040-1710342 ◽

2020 ◽

Vol 06 (02) ◽

pp. e128-e130

Author(s):

Shiva Poola ◽

Shachar Laks ◽

Peter Kragel ◽

Kara Regan

Keyword(s):

High Risk ◽

Pancreatic Cyst ◽

Imaging Techniques ◽

Accessory Spleen ◽

Needle Aspiration ◽

Pancreatic Cysts ◽

Cross Sectional ◽

Intrapancreatic Accessory Spleen ◽

Cross Sectional Imaging ◽

Magnetic Resonance Imaging Mri

AbstractIncidentally discovered pancreatic cysts have become more common with increasing use of abdominal cross-sectional imaging. Tools that help us to better risk stratify a pancreatic cyst include advanced imaging techniques, such as pancreatic protocol computed tomography (CT) scan or magnetic resonance imaging (MRI) with cholangiopancreatography. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are invasive measures to better define and sample cysts especially if high-risk features are present. EUS may also yield pancreatic cyst fluid for analysis of carcinoembryonic antigen (CEA) which is elevated in mucinous cysts. This case highlights a rare finding of a mucinous, epidermoid cyst in an intrapancreatic accessory spleen (IPAS) with high-risk features on EUS.

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Correlation between serum carbohydrate antigen 19-9 levels and computed tomography severity score in patients with nontuberculous mycobacterial pulmonary disease

Scientific Reports ◽

10.1038/s41598-021-82363-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kangjoon Kim ◽

Seung Hyun Yong ◽

Su Hwan Lee ◽

Sang Hoon Lee ◽

Ah Young Leem ◽

...

Keyword(s):

Computed Tomography ◽

Disease Activity ◽

Pulmonary Disease ◽

Severity Score ◽

Partial Correlation ◽

Elevated Serum ◽

Carbohydrate Antigen ◽

Chest Ct ◽

Clinical Biomarker ◽

Serum Carbohydrate Antigen

AbstractThere is no validated clinical biomarker for disease severity or treatment response for nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the correlation between elevated serum carbohydrate antigen (CA) 19-9 levels and NTM-PD disease activity, defined using an imaging severity score based on chest computed tomography (CT). We retrospectively examined 79 patients with NTM-PD who underwent serum CA19-9 level assessments and chest CT less than 1 month apart. NTM-PD severity was rated using a CT-based scoring system. The correlation between the CT score and serum CA19-9 levels was evaluated. Chest CT revealed nodular bronchiectasis without cavitation in most patients (78.5%). Serum CA19-9 levels were elevated in 19 (24%) patients. Serum CA19-9 levels were positively correlated with the total CT score and bronchiectasis, bronchiolitis, cavity, and consolidation subscores. Partial correlation analysis revealed a significant positive correlation between serum CA19-9 levels and CT scores for total score and bronchiectasis, bronchiolitis, cavitation, and consolidation subscores after controlling for age, sex, and BMI. Serum CA19-9 levels were positively correlated with the CT severity score for NTM-PD. Serum CA19-9 may be useful in evaluating disease activity or therapeutic response in patients with NTM-PD.

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Management Guidelines for Pancreatic Cystic Lesions: Should we Adopt or Adapt the Current Roadmaps?

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-341 ◽

2019 ◽

Vol 28 (4) ◽

pp. 495-501 ◽

Cited By ~ 1

Author(s):

Filipe Vilas-Boas ◽

Guilherme Macedo

Keyword(s):

Needle Aspiration ◽

Pancreatic Cysts ◽

Cystic Lesions ◽

International Consensus ◽

Cross Sectional ◽

Fluid Analysis ◽

Mucinous Neoplasms ◽

Cross Sectional Imaging ◽

History Of ◽

International Consensus Guidelines

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

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