Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions

Abstract

Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines, is also discussed, with special reference to intraductal papillary mucinous neoplasm (IPMN; particularly the branch duct variant), which is the lesion most frequently identified incidentally. IPMN pathology, its risk for development into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk are discussed. Finally, surgical treatment, strategies for surveillance of pancreatic cysts, and possible future directions are discussed.

Keywords: Cyst fluid; Endoscopic ultrasound; Intraductal papillary mucinous neoplasm; Pancreatic cyst.

Fig. 1

The Fukuoka guidelines for the management of presumed BD-IPMN and MCN. BD-IPMN, branch-duct intraductal papillary mucinous neoplasm; MCN, mucinous cystic neoplasm; CT, computed tomography; MRI, magnetic resonance imaging, EUS, endoscopic ultrasound.