Advances in the Diagnosis of Pancreatic Cystic Lesions

Abstract

Pancreatic cystic lesions (PCLs) are a heterogenous group of lesions ranging from benign to malignant. There has been an increase in PCLs prevalence in recent years, mostly due to advances in imaging techniques, increased awareness of their existence and population aging. Reliable discrimination between neoplastic and non-neoplastic cystic lesions is paramount to ensuring adequate treatment and follow-up. Although conventional diagnostic techniques such as ultrasound (US), magnetic resonance imaging (MRI) and computer tomography (CT) can easily identify these lesions, assessing the risk of malignancy is limited. Endoscopic ultrasound (EUS) is superior to cross-sectional imaging in identifying potentially malignant lesions due to its high resolution and better imaging characteristics, and the advantage of allowing for cyst fluid sampling via fine-needle aspiration (FNA). More complex testing, such as cytological and histopathological analysis and biochemical and molecular testing of the aspirated fluid, can ensure an accurate diagnosis.

Keywords: endoscopic ultrasound; fine-needle aspiration; intraductal papillary mucinous neoplasm; pancreatic cystic lesion; pancreatic cystic neoplasm.

Figure 1

Algorithm of pancreatic cystic lesions (PCLs) diagnosis and management. * Radiographic features diagnostic of a serous cystadenoma are its microcystic appearance and presence of a stellate central scar.

Figure 2

Small (3 mm) mural nodule (red arrow) in a pancreatic cyst—presumably an IPMN, appearing hyperenhanced on contrast-enhanced EUS examination; thus, it is undoubtedly a true mural nodule.