Journal List > Korean J Gastroenterol > v.55(3) > 1006636

Lee: Clinical Approach to Incidental Pancreatic Cystic Lesions

Abstract

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the ma-jority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning longterm follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established.

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Fig. 1.
Clinical approch to pancreatic cystic lesions. SCA, serous cystadenoma; MCT, mucinous cystic tumor; IPMN, intraductal papillary mucinous neoplasm; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; FNA, fine needle aspiration; MPD, main pancreatic duct; USG, ultrasonography; CT, computed tomography.
kjg-55-154f1.tif
Table 1.
Classification of Cystic Pancreatic Lesions
Nonneoplastic cysts
Pseudocyst
Congenital cyst
Cystic neoplasms
Serous cystadenoma
Mucinous cystic neoplasm
Intraductal papillary mucinous neoplasm
Cystic degeneration of solid tumor
Solid pseudopapillary tumor
Cystic endocrine tumor
Cystic ductal adenocarcinoma
Table 2.
Clinical Characteristics of Pancreatic Cystic Lesions
Gender Age Location Morphology Type of epithelium ERCP/MRCP finding Risk of maligancy
SCA Female> Male 50-60 Evenly Microcystic Serous Normal Rare
MCN Female, mostly 50-60 Body/Tail Unilocular, septated Mucinous Normal Moderate
IPMN Male> Female 60-70 Head Multilocular Papillary mucinous Dilated main ducts, commu- nication with branch duct Moderate
SPT Female, mostly 30-40 Evenly Mixed solid and cystic Endocrine-like Normal Low

SCA, serous cystadenoma; MCN, mucinous cystic neoplasm; IPMN, intraductal papillary mucinous neoplasm; SPT, solid pseudopapillary tumor.

Table 3.
Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, and Accuracy of CEA, CA19-9, and Cytology of Cystic Fluid
Cutoff Diagnosis Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%)
Amylase <250 U/L SCA, MCA, MCAC 44 98 98 53 65
CEA <5 ng/mL SCA, PC 50 95 94 55 67
CEA >800 ng/mL MCA, MCAC 48 98 94 75 79
CA 19-9 <37 U/mL SCA, PC 19 98 94 38 46
Cytology: malignant cells MCAC 48 100 (?)

PPV, positive predictive value; NPV, negative predictive value; CEA, carcinoembryonic antigen; CA, carbohydrate-associated antigen; SCA, serous cystadenoma; MCA, mucinous cystadenoma; MCAC, mucinous cystadenocarcinoma; PC, pseudocysts.

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