Pancreatic Cysts

Pancreatic cysts are more common than before, largely because of widespread abdominal imaging. Pancreatic cystic neoplasms (PCN) are relevant to risk selection on 2 counts: they constitute more than 50% of all pancreatic cysts and, in contrast to the other 2 cyst types, are capable of malignant transformation. The majority of PCNs are benign at time of diagnosis and will follow a benign course. The challenge is to identify those PCNs that are malignant or will undergo malignant transformation with time. The purpose of this article is to provide pointers that can help meet this challenge while also summarizing the ongoing debate about their optimal management.

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Survival in Cystic Neoplasms of the Pancreas

Canadian Journal of Gastroenterology ◽

10.1155/2009/139780 ◽

2009 ◽

Vol 23 (8) ◽

pp. 537-542 ◽

Cited By ~ 7

Author(s):

Ali Cadili ◽

Amy Bazzerelli ◽

Sipi Garg ◽

Robert Bailey

Keyword(s):

Overall Survival ◽

Pancreatic Cyst ◽

Patient Survival ◽

Survival Rates ◽

Pancreatic Cysts ◽

Cystic Neoplasms ◽

Patient Age ◽

Patient Âgé ◽

History Of ◽

Pancreatic Cystic Neoplasms

BACKGROUND: The natural history of pancreatic cystic neoplasms remains poorly understood despite growing evidence on the subject. Pancreatic cysts display a wide spectrum of pathological phenotypes, each associated with a different prognostic implication. Many pancreatic cysts are of undetermined malignant potential at presentation and remain so until surgically resected. While the survival rates of patients with malignant cysts are known to be poor, survival rates in patients with undetermined pancreatic cysts are unknown.OBJECTIVE: To identify the factors associated with survival in a group of patients diagnosed with a pancreatic cyst(s).METHODS: The present study was a retrospective multicentre review of pancreatic cystic neoplasms. All patients with a diagnosis of a neoplastic pancreatic cyst from 1994 to 2003 were identified at five different institutions in Edmonton, Alberta. The data collected included patient age, sex, imaging modality, cyst location, cyst size, number of cysts, comorbid illnesses, history of upper abdominal surgery, previous cancer, previous or concurrent metastases, symptoms (pain, upper gastrointestinal bleeding, signs of biliary obstruction, nausea/vomiting), remarkable radiological features, elevated amylase or lipase, type of pancreatic surgery, final pathology (benign or malignant) and overall survival. Survival models were used to assess whether any covariates were predictors of the survival time. Patient data were plotted using the Kaplan-Meier method. The resulting plot was used to calculate survival in the cohort.RESULTS: In total, 64 patients were identified as having neoplastic pancreatic cysts from 1994 to 2003 at the five institutions. The median overall patient survival time was 86 months. The median age at diagnosis for the patient population was 73 years, with 40 patients being women. Univariate analysis revealed that the risk of death was associated with patient age, sex and history of major comorbid illness. Multivariate models identified increased patient age and male sex as the factors that correlated most strongly with decreased overall survival.CONCLUSION: Overall survival in patients with neoplastic pancreatic cysts is determined by patient factors (ie, age and sex) rather than factors descriptive of the cyst such as size and morphology. No conclusions could be made regarding the relationship between cyst pathology and patient survival.

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The Outcome of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Cystic Neoplasms: A Systematic Review

Clinical Oncology and Research ◽

10.31487/j.cor.2020.08.23 ◽

2020 ◽

pp. 1-6

Author(s):

Viswanath YKS ◽

Ahmed Mehanna ◽

Viswanath YKS ◽

Talvinder Gill ◽

Anil Reddy ◽

...

Keyword(s):

Systematic Review ◽

Malignant Tumors ◽

High Specificity ◽

Needle Aspiration ◽

Pancreatic Cysts ◽

Cystic Neoplasms ◽

Pancreatic Cystic Neoplasms ◽

Low Sensitivity ◽

The Uk

Introduction: Pancreatic cancer is the sixth most common cause of death from cancer in the UK. Cystic pancreatic neoplasms are being recognized more with the increase in the use of the CT scan. EUS has been increasingly used to asses and identify lesions in the pancreas, however, it can’t differentiate between benign and malignant tumors alone. The role of EUS guided FNA cytology (EUS FNAC) is still controversial in the management of pancreatic cysts where neoplastic process is questioned. Aim: This systematic review is aiming to explore the currently available evidence assessing the role of EUS guided FNA cytology (EUS FNAC) in the management of pancreatic cystic neoplasms. Methods: A total of five studies with 597 patient EUS FNAC episodes were included in this systematic review. Results: The sensitivity of the EUS FNAC in the papers was variable between 46.7% to 91.7% while the sensitivity of the test was 100% for all the papers except for 1 paper which was 82.1%. CEA level was assessed in 3 papers, however, the cut off level was different. Conclusion: The high specificity of EUS FNAC qualify it as a useful adjunct to ascertain or exclude malignancy in the pancreatic cystic lesions. EUS FNAC cannot be used alone as a method of screening, given low sensitivity. Measuring CEA in the cyst fluid can be a good aide to increase the sensitivity and an identifiable cut off level should be proposed. Well-conducted and powered studies are needed to further explore the role of EUS FNAC in patients with pancreatic cystic neoplastic lesions.

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Interdisciplinary Management of Cystic Neoplasms of the Pancreas

Gastroenterology Research and Practice ◽

10.1155/2012/513163 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Linda S. Lee ◽

Thomas Clancy ◽

Vivek Kadiyala ◽

Shadeah Suleiman ◽

Darwin L. Conwell

Keyword(s):

Wide Spectrum ◽

Interdisciplinary Approach ◽

Premalignant Lesions ◽

Pancreatic Cysts ◽

Interdisciplinary Management ◽

Cystic Neoplasms ◽

Cross Sectional ◽

Frequent Use ◽

Pancreatic Cystic Neoplasms ◽

Pathologic Analysis

Cystic neoplasms of the pancreas are increasingly recognized due to the frequent use of abdominal imaging. It is reported that up to 20% of abdominal cross-sectional scans identify incidental asymptomatic pancreatic cysts. Proper characterization of pancreatic cystic neoplasms is important not only to recognize premalignant lesions that will require surgical resection, but also to allow nonoperative management of many cystic lesions that will not require resection with its inherent morbidity. Though reliable biomarkers are lacking, a wide spectrum of diagnostic modalities are available to evaluate pancreatic cystic neoplasms, including radiologic, endoscopic, laboratory, and pathologic analysis. An interdisciplinary approach to management of these lesions which incorporates recent, specialty-specific advances in the medical literature is herein suggested.

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Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk

Radiologia Brasileira ◽

10.1590/0100-3984.2017.0105 ◽

2018 ◽

Vol 51 (4) ◽

pp. 218-224 ◽

Cited By ~ 2

Author(s):

Aline Falqueto ◽

Gustavo Lemos Pelandré ◽

Mariânges Zadrozny Gouvêa da Costa ◽

Marcelo Souto Nacif ◽

Edson Marchiori

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Demographic Data ◽

Cross Sectional Study ◽

Pancreatic Cysts ◽

Resonance Imaging ◽

Cystic Neoplasms ◽

Cross Sectional ◽

Malignancy Risk ◽

Pancreatic Cystic Neoplasms

Abstract Objective: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. Materials and methods: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. Results: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. Conclusion: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

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Malignant transformation of incidental pancreatic cystic neoplasms

Pancreatology ◽

10.1016/j.pan.2016.05.166 ◽

2016 ◽

Vol 16 (3) ◽

pp. S48-S49

Author(s):

Jae Seon Kim ◽

Hyo Jung Kim ◽

Moon Kyung Joo ◽

Jong-Jae Park ◽

Young-Tae Bak

Keyword(s):

Malignant Transformation ◽

Cystic Neoplasms ◽

Pancreatic Cystic Neoplasms

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Determining when endoscopic ultrasound (EUS) changes management for patients with pancreatic cystic neoplasms.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.641 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 641-641

Author(s):

Hasrit Sidhu ◽

Khaola Maher ◽

Dave Farnell ◽

Leo Chen ◽

Ian Gan ◽

...

Keyword(s):

High Risk ◽

Patient Management ◽

High Specificity ◽

Pancreatic Cysts ◽

Cystic Neoplasms ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Pancreatic Cystic Neoplasms ◽

Low Sensitivity ◽

Ct And Mri

641 Background: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to the widespread use of CT and MRI. CT and MRI cannot always differentiate between malignant and benign PCNs. EUS is an emerging tool that provides higher quality descriptions of pancreatic cysts and can be used to differentiate between benign and malignant features. Considering that EUS is a resource dependent tool, we hope to identify the PCN cases in which EUS changes management. Methods: We conducted a retrospective case-control chart review evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS for analysis between January 1, 2010 and December 31, 2017. We determined whether EUS correctly identified high-risk features (HRFs) relative to CT/MRI and whether EUS upstaged or downstaged the CT/MRI diagnosis to change overall patient management. Results: EUS was found to have a high specificity (> 95%) for all high-risk features identified in the AGA and FG guidelines and a low sensitivity ( < 70%) for all high risk features except cyst size > 3cm (82.35%) and mural nodule < 5mm (100%). EUS was found to change management in 29.4% of cases (18.2% upstaged, 11.2% downstaged). EUS screening led to a total of three adenocarcinoma diagnoses, in which two were reported to be invasive. Conclusions: The high specificity of EUS supports its use in the differentiation of high risk PCNs identified on cross-sectional imaging. Its low sensitivity indicates that the reliance on operator experience may be a substantial limitation resulting in inconclusive diagnoses. In conclusion, considering that EUS is successful in changing patient management of PCNs, it should be readily referred when any HRF is identified on cross-sectional imaging.

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Evaluating the accuracy of three international guidelines in identifying the risk of malignancy in pancreatic cysts : a retrospective analysis of a surgical treated population

Acta Gastro Enterologica Belgica ◽

10.51821/84.3.006 ◽

2021 ◽

Vol 84 (3) ◽

Author(s):

A Vanden Bulcke ◽

J Jaekers ◽

H Topal ◽

D Vanbeckevoort ◽

V Vandecaveye ◽

...

Keyword(s):

Retrospective Analysis ◽

Neuroendocrine Tumour ◽

Pancreatic Cysts ◽

International Consensus ◽

Cystic Neoplasms ◽

Study Results ◽

Risk Of Malignancy ◽

Pancreatic Cystic Neoplasms ◽

Evidence Based Guideline ◽

The Cost

Background and study aims : The international consensus Fukuoka guideline (Fukuoka ICG), The European evidence-based guideline on pancreatic cystic neoplasms (European EBG) and the American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts (AGA IG) are 3 frequently cited guidelines for the risk stratification of neoplastic pancreatic cysts. The aim of this study was to assess the accuracy of detecting malignant cysts by strictly applying these guidelines retrospectively to a cohort of surgically resected pancreatic cysts. Patient and methods : 72 resected cysts were included in the analysis. Invasive carcinoma, high grade dysplasia and neuroendocrine tumour were considered as “malignant cysts” for the purpose of the study. Results : 32% of the resected cysts were malignant. The analysis showed that the Fukuoka ICG, European EBG and AGA IG had a sensitivity of 66,8%, 95,5%, 80%; a specificity of 26,8%, 11,3%, 43,8%; a positive predictive value of 31,8%, 35%, 47,1% and a negative predicted value of 61,1%, 83,3%, 77,8% respectively. The missed malignancy rate was respectively 11,3%, 1,5%, 7,7% and surgical overtreatment was respectively 48,4%, 59,1%, 34,6%. Conclusion : In this retrospective analysis, the European EBG had the lowest rate of missed malignancy at the expense of a high number of “unnecessary” resections. The Fukuoka ICG had the highest number of missed malignancy. The AGA IG showed the lowest rate of unnecessary surgery at the cost of a high number of missed malignancy. There is need to develop better biomarkers to predict the risk of malignancy.

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