Recent Advances in Diagnosis and Treatment of Pancreatic Cysts

Abstract

Summary P ancreatic cystic lesions present a challenge to clinicians due to their increased incidental identification on radiology imaging and the limitations of currently available diagnostic tools. Their pathology ranges from pseudocysts and pancreatic necrosis to benign and malignant neoplasms. Pancreatic cystic lesions may be encountered during the evaluation of a patient with pancreatitis or abdominal pain; but often these lesions are found incidentally during abdominal imaging performed for unrelated reasons. Because of their radiographic appearance, pancreatic cystic neoplasms frequently are misclassified as pseudocysts. Diagnosis of these lesions relies mainly on the combination of diagnostic imaging and analysis of cyst fluid obtained during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unfortunately, the imaging characteristics of pancreatic cysts can be similar, making differentiation between benign and premalignant lesions difficult. In addition, current cyst fluid analysis techniques fail to clearly distinguish among the different types of pancreatic cysts as well as predict the behavior of these lesions. The accurate classification of pancreatic cysts is important since premalignant lesions may require surgical resection, while others that are benign or indolent can be observed. Since radiological features, cyst fluid analysis and even operative differentiation with frozen section cannot always accurately discriminate between the various cystic lesions, the only definitive way of excluding a cystic tumour is complete excision. Several EUS findings have been evaluated to diagnose pancreatic cystic lesions. Certain features do appear to be more predictive in diagnosing particular types of cystic lesions. EUS findings by themselves are not accurate enough to definitively diagnose the type of cystic lesion of the pancreas or to determine its malignant potential.