Management of Pancreatic Cystic Lesions: Making Sense of All the Guidelines
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Pancreas (C Forsmark, Section Editor)
Management of Pancreatic Cystic Lesions: Making Sense of All the Guidelines Salmaan Jawaid, MD1,* Peter V. Draganov, MD2 Dennis Yang, MD2 Address *,1 Division of Gastroenterology and Hepataology, Baylor College of Medicine, Houston, TX, USA Email: [email protected] 2 Division of Gastroenterology and Hepatology, University of Florida Health, Gainesville, FL, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Pancreas Keywords Pancreatic cysts I Pancreatic cancer I EUS (endoscopic ultrasound) I Guidelines
Abstract Purpose of review Pancreatic cystic lesions are now being identified in increasing frequency, providing an opportunity for early detection of advanced neoplasia. Multiple guidelines have been developed to help risk-stratify pancreatic cystic lesions. However, differences between guidelines provide a source of confusion for most practitioners. In this review, we attempt to highlight the similarities and differences between the guidelines, specifically evaluating their target populations and variations in surveillance/ management strategies for pancreatic cystic lesions. Recent findings The most commonly used guidelines provide varying strategies for the management and surveillance of pancreatic cystic lesions. By providing a consolidated and updated review of the literature, we find no one guideline performs better than the others. Summary Despite existing guidelines, the most optimal risk stratification strategy for pancreatic cystic lesions remains unclear. However, advances in enhanced imaging modalities, cyst fluid analysis, and other biomarkers may offer effective options in the future.
Introduction Pancreatic cystic lesions are being diagnosed with increasing frequency, partly due to the pervasive use of high-quality cross-sectional imaging in clinical
practice [1]. Most of these incidental lesions are pancreatic cystic neoplasms (PCNs), which represent a heterogeneous group of cysts that include intraductal
Pancreas (C Forsmark, Section Editor) papillary mucinous neoplasm (IPMN), mucinous cystic neoplasms (MCNs), serous cystadenomas (SCAs), and other rare entities, such as solid pseudopapillary neoplasms (SPNs) and cystic neuroendocrine tumors (cNETs). The prevalence of PCNs can vary markedly based on the type of imaging, but it has been estimated to be between 8 and 13.5% in the general population [2, 3]. Due to the prevalence,
varying degrees of malignant potential, and their uncertain behavior, PCNs are a clinical challenge and a source of angst for both patients and providers alike [3]. Accurate diagnosis and risk stratification are crucial to direct the most appropriate management strategy, which includes surgery, surveillance, or doing nothing.
Types of PCNs PCNs account for different biological entities with varying degrees of malignant potential. Overall, PCNs can be classified as either non-mucinous (SCA, SPN, cNET) or mucinous (IPMN, MCN) [4]. The main imaging and clinical
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