Pancreatic Cystic Neoplasms: Diagnosis and Management
Abstract
:1. Introduction
2. Classification/Definition
2.1. Mucinous Cystic Neoplasms
2.2. Intraductal Papillary Mucinous Neoplasms
2.3. Serous Cystic Neoplasm
2.4. Solid Pseudopapillary Neoplasm
2.5. Cystic Neuroendocrine Tumors
3. Diagnosis
3.1. Cyst Fluid Analysis and Next-Generation Sequencing
3.2. Endoscopic Ultrasound-Guided Through-the-Needle Microforceps Biopsy
3.3. Needle Confocal Laser Endomicroscopy
4. Surgical Resection
4.1. Cyst Size
4.2. Pancreatic Ductal Dilatation
4.3. Symptoms
4.4. Enhancing Mural Nodule
2015 AGA [32] | MCN | - |
IPMN | - | |
2017 IAP [30] | MCN | - |
IPMN |
| |
2018 European [29] | MCN | - |
IPMN |
| |
2018 ACG [10] | MCN | - |
IPMN |
|
5. Surveillance
5.1. Active Surveillance of Non-Resected PCNs
5.2. Surveillance after Surgical Resection of PCNs
6. Future Directions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Society | American College of Gastroenterology (2018) [10] | European Guideline (2018) [29] | International Association of Pancreatology (2017) [30] | American Society of Gastrointestinal Endoscopy (2016) [31] | American Gastrointestinal Association (2015) [32] |
Cyst Diameter | >3 cm diameter | N/A | >3 cm diameter | >3 cm diameter | >3 cm diameter |
Pancreatic Duct Dilatation | Yes | N/A | Yes, also an abrupt change in the caliber of the pancreatic duct with distal pancreatic atrophy | Yes | Yes |
Nodule | Yes | N/A | Enhancing mural nodule <5 mm | Presence of epithelial nodule or suspicious mass lesion | Yes |
Rate of Growth | Cyst growth rate greater than 3 mm per year | N/A | Cyst growth rate greater than or equal to 5 mm over 2 years | N/A | |
Biomarker | Elevated Ca 19-9 | N/A | Elevated Ca 19-9 | N/A | |
Symptoms | Jaundice or Acute Pancreatitis | N/A | N/A | N/A | N/A |
Additional Recommendations | If not clearly an IPMN or MCN based on cross-sectional imaging, EUS-FNA is recommended. | EUS-(FNA) should only be performed when the results are expected to change clinical management or PCN has either clinical or radiological features of concern identified during the initial investigation or surveillance. | Thickened/enhancing cyst walls, Lymphadenopathy | EUS-FNA is optional for cysts <3 cm without other indications for performing EUS-FNA. |
Guideline | Cyst Type | Size | Pancreatic Duct Dilatation | Symptoms | Enhancing Mural Nodule | Cytology Positive for Malignancy |
---|---|---|---|---|---|---|
2015 AGA [32] | MCN | All | All | All | All | All |
IPMN | - | >5 mm and solid component | - | - | Yes | |
2017 IAP [30] | MCN | All | All | All | All | All |
IPMN | ≥5 mm | ≥10 mm | Jaundice | Yes | Yes | |
2018 European [29] | MCN | ≥40 mm | - | Jaundice, acute pancreatitis, new-onset diabetes mellitus | Yes | - |
IPMN | - | ≥10 mm | Jaundice | Yes ≥5 mm | Yes | |
cNET | >20 mm | - | - | - | Yes | |
2018 ACG [10] | MCN | - | - | - | - | - |
IPMN | - | - | - | - | - |
Guideline | Cyst Type | Cyst Size | Surveillance Interval | Imaging Modality | When to Lengthen Interval or Stop If Stable |
---|---|---|---|---|---|
2015 AGA [32] | IPMN | <30 mm | Yearly for 1 year, then every 2 years | MRI with MRCP | Stop after 5 years |
2017 IAP [30] | IPMN | <10 mm | 6 months and then every 2 years | CT or MRI with MRCP | Lengthen interval after 3 years |
10–20 mm | Every 6 months for one year and then yearly for every 2 years | CT or MRI with MRCP | Lengthen interval after 3 years | ||
20–30 mm | 3–6 months, then yearly | EUS alternating MRI with EUS | Lifelong surveillance | ||
2018 European [29] | MCN and IPMN | <40 mm | Every 6 months for 1 year, then yearly | Ca-19-9, EUS and/or MRI | Lifelong surveillance |
cNET | <20 mm | No guidance on interval or screening modality | |||
2018 ACG [10] | MCN and IPMN | <10 mm | Every 2 years | MRI | Lifelong surveillance |
10–20 mm | Yearly for 3 years, then every 2 years | MRI | Lifelong surveillance | ||
20–30 mm | Every 6–12 months for 3 years, then yearly | MRI or EUS then MRI | Lifelong surveillance |
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Schubach, A.; Kothari, S.; Kothari, T. Pancreatic Cystic Neoplasms: Diagnosis and Management. Diagnostics 2023, 13, 207. https://doi.org/10.3390/diagnostics13020207
Schubach A, Kothari S, Kothari T. Pancreatic Cystic Neoplasms: Diagnosis and Management. Diagnostics. 2023; 13(2):207. https://doi.org/10.3390/diagnostics13020207
Chicago/Turabian StyleSchubach, Abigail, Shivangi Kothari, and Truptesh Kothari. 2023. "Pancreatic Cystic Neoplasms: Diagnosis and Management" Diagnostics 13, no. 2: 207. https://doi.org/10.3390/diagnostics13020207