Abstract
Improvements in the sensitivity and quality of cross-sectional imaging have led to increasing numbers of patients being diagnosed with cystic lesions of the pancreas. In parallel, clinical, radiological, pathological and molecular studies have improved the systems for classifying these cysts. Patients with asymptomatic serous cystic neoplasms can be managed conservatively with regular monitoring; however, the clinical management of patients with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms is far more challenging, as it is difficult to determine whether these lesions will progress to malignancy. Fortunately, prospective studies have helped to establish that proposed clinical and radiological criteria (the Sendai guidelines) can be used to guide the care of patients with cystic lesions of the pancreas. Despite this progress in imaging and clinical guidelines, sensitive and specific tests have not yet been developed that can reliably predict the histology and biological properties of a cystic lesion. Such biomarkers are urgently needed, as noninvasive precursors of pancreatic cancer are curable, while the vast majority of invasive pancreatic adenocarcinomas are not.
Key Points
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The number of patients being diagnosed with pancreatic cysts is increasing dramatically owing to the widespread use of high resolution imaging modalities
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Although some pancreatic cysts are benign, others (such as intraductal papillary mucinous neoplasms or mucinous cystic neoplasms) are precursor lesions of invasive pancreatic cancer that might undergo malignant transformation
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Diagnosis and risk assessment of pancreatic cystic lesions before surgery is challenging, which hampers the implementation of an appropriate therapeutic stratification
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Ongoing research is trying to discover diagnostic targets to enable a tailor-made approach to the treatment of patients with pancreatic cystic lesions
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The discovery of biomarkers in pancreatic cyst fluid (a readily available clinical specimen) is believed to provide diagnostic targets for translation into improved clinical management of patients with pancreatic cysts
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Acknowledgements
The authors wish to thank Dr Karen M. Horton (Johns Hopkins University) for the CT scan of multifocal IPMN used in Figure 1. The authors would like to acknowledge the support of grants P50CA062924 and R01CA113669 (A. Maitra) and a research fellowship grant from Deutsche Krebshilfe, Bonn, Germany (H. Matthaei), the Sol Goldman Pancreatic Cancer Research Center and the Michael Rolfe Foundation for Pancreatic Cancer Research.C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.
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Matthaei, H., Schulick, R., Hruban, R. et al. Cystic precursors to invasive pancreatic cancer. Nat Rev Gastroenterol Hepatol 8, 141–150 (2011). https://doi.org/10.1038/nrgastro.2011.2
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