p.4
Types of Pancreatic Cysts
What type of pancreatic tumors are usually non-functioning and rare?
Cystic pancreatic neuroendocrine tumors.
p.7
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the role of EUS in diagnosing pancreatic cysts?
It is accurate for diagnosing benign from malignant cysts and identifying mural nodules.
p.7
Diagnosis and Imaging Techniques for Pancreatic Cysts
What imaging technique is no longer recommended for pancreatic cyst diagnosis or surveillance?
ERCP (Endoscopic Retrograde Cholangiopancreatography).
p.7
Diagnosis and Imaging Techniques for Pancreatic Cysts
What imaging technique improves visualization of communication between the main pancreatic duct and a pancreatic cyst?
Secretin-stimulated MRCP.
p.4
Diagnosis and Imaging Techniques for Pancreatic Cysts
What imaging technique is often required for an accurate diagnosis of pancreatic cysts?
EUS-guided fine needle aspiration (FNA).
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the role of EUS-FNA in the management of pancreatic cysts?
EUS-FNA is used to characterize the type of pancreatic cyst and can help differentiate between IPMNs and MCNs from other cyst types.
p.9
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the pooled specificity and sensitivity of cytology for pancreatic cancer?
Specificity is 90.6%, while sensitivity is 64.8%.
p.6
Surveillance Recommendations for Pancreatic Cysts
What should be done if a pancreatic cyst shows an increase in size?
Consider shorter interval imaging with MRI or EUS ± FNA within 6 months.
p.9
Surveillance Recommendations for Pancreatic Cysts
What is the significance of early detection and intervention in pancreatic cysts?
It may improve survival rates for patients with high-grade dysplasia or very early pancreatic cancer.
p.7
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the diagnostic accuracy of PET/CT compared to MDCT and MRI?
PET/CT had a diagnostic accuracy of 94%, compared to 77% for MDCT.
p.3
Surveillance Recommendations for Pancreatic Cysts
What is the follow-up recommendation for patients with resected serous cystadenoma or pseudocyst?
They do not require any follow-up after resection.
p.5
Risk of Malignant Transformation in Pancreatic Cysts
What are high-risk characteristics for mucinous pancreatic cysts?
Symptoms like jaundice, acute pancreatitis, elevated serum CA 19-9, and specific imaging findings.
p.7
Patient Selection for Surgical Intervention
Which patients should not undergo further evaluation of incidentally found pancreatic cysts?
Patients who are not medically fit for surgery.
p.3
Diagnosis and Imaging Techniques for Pancreatic Cysts
What should be considered for indeterminate cysts?
A second imaging modality or cyst fluid analysis via endoscopic ultrasound (EUS).
p.9
Patient Selection for Surgical Intervention
What should be considered before starting cyst surveillance?
The patient's risk of developing pancreatic malignancy, life expectancy, comorbid conditions, and surgical candidacy.
p.9
Clinical Guidelines for Pancreatic Cyst Management
What imaging findings warrant referral to a multidisciplinary pancreatic group?
Presence of a mural nodule, solid component, dilation of the main pancreatic duct >5 mm, or IPMNs/MCNs measuring ≥3 cm.
p.2
Clinical Guidelines for Pancreatic Cyst Management
What should be considered when analyzing the risks posed by pancreatic cysts?
Individual life expectancy and risk of death from other factors.
p.6
Diagnosis and Imaging Techniques for Pancreatic Cysts
What imaging techniques are recommended for characterizing pancreatic cysts?
MRI or magnetic resonance cholangiopancreatography (MRCP).
p.2
Clinical Guidelines for Pancreatic Cyst Management
What must management decisions for pancreatic cysts consider?
The low risk of malignancy vs. their frequent detection.
p.2
Types of Pancreatic Cysts
What is the most common type of pancreatic cyst?
Intraductal papillary mucinous neoplasm (IPMN).
p.7
Management and Treatment Options for Pancreatic Cysts
What is the recommendation for patients with asymptomatic cysts diagnosed as pseudocysts?
They do not require treatment or further evaluation.
p.3
Surveillance Recommendations for Pancreatic Cysts
How often should patients be followed after resection of a solid-pseudopapillary neoplasm?
On a yearly basis for at least 5 years.
p.3
Diagnosis and Imaging Techniques for Pancreatic Cysts
What imaging techniques are preferred for pancreatic cyst diagnosis?
Magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP) due to their non-invasiveness and accuracy.
p.3
Management and Treatment Options for Pancreatic Cysts
What is recommended for patients not medically fit for surgery regarding pancreatic cysts?
They should not undergo further evaluation of incidentally found pancreatic cysts, regardless of size.
p.2
Risk of Malignant Transformation in Pancreatic Cysts
What is the risk of malignant transformation in main duct IPMNs?
38–68% harbor high-grade dysplasia or pancreatic cancer.
p.4
Types of Pancreatic Cysts
What is the clinical association of a pseudocyst?
Acute and/or chronic pancreatitis.
p.2
Types of Pancreatic Cysts
What is the typical presentation of solid-pseudopapillary neoplasms (SPNs)?
More common in women, frequently presenting in their 20s.
p.4
Prevalence and Incidence of Pancreatic Cysts
What are the most common presentations of pancreatic cysts?
Abdominal pain (63%) and incidental/asymptomatic (38%).
p.3
Surveillance Recommendations for Pancreatic Cysts
What should be done for patients with IPMNs or MCNs showing new-onset diabetes or rapid cyst growth?
They should undergo short-interval MRI or EUS±FNA due to increased risk of malignancy.
p.8
Management and Treatment Options for Pancreatic Cysts
What should be done if an asymptomatic cyst is diagnosed as a non-neoplastic cyst?
No further treatment or evaluation is warranted.
p.9
Management and Treatment Options for Pancreatic Cysts
What is the current evidence regarding the routine use of cyst ablation?
There is insufficient evidence to support its routine use; it may be considered for patients who refuse or are not candidates for surgery.
p.7
Patient Selection for Surgical Intervention
What is the Charlson comorbidity index (CACI) used for in patients with IPMNs?
To predict mortality based on various health conditions.
p.3
Management and Treatment Options for Pancreatic Cysts
When should EUS-FNA and cyst fluid analysis be considered?
In cysts where the diagnosis is unclear and results are likely to alter management.
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the significance of cyst fluid CEA levels in diagnosing pancreatic cysts?
Cyst fluid CEA is commonly used to identify IPMNs and MCNs, with a sensitivity of 63% and specificity of 93% at a cutoff level of 192 ng/ml.
p.9
Cost-Effectiveness of Cyst Surveillance
What is the current understanding of the survival benefit of cyst surveillance?
The utility of surveillance is unproven, as there are no prospective studies determining its effect on mortality.
p.1
Clinical Guidelines for Pancreatic Cyst Management
What challenges exist in the management of pancreatic cysts?
Contradictory recommendations due to small risk of malignant transformation and high surgical risks.
p.6
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is a key characteristic of side-branch IPMNs that MRI or MRCP can assess?
Communication between the main pancreatic duct and the cyst.
p.3
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the accuracy of MRI or MRCP in diagnosing cyst type?
40-50% for cyst type and 55-76% for distinguishing benign from malignant.
p.5
Diagnosis and Imaging Techniques for Pancreatic Cysts
What are the four levels of evidence used in assessing pancreatic cysts?
High, moderate, low, and very low.
p.2
Types of Pancreatic Cysts
What is a characteristic feature of mucinous cystic neoplasms (MCNs)?
They occur almost exclusively in women and are often found in the body or tail of the pancreas.
p.2
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is a common diagnostic tool for assessing pancreatic cysts?
Endoscopic ultrasound (EUS) with fine needle aspiration (FNA).
p.5
Management and Treatment Options for Pancreatic Cysts
What is the recommended follow-up for a cyst that is ≥ 3 cm?
Refer to a multidisciplinary group and consider EUS ± FNA.
p.6
Surveillance Recommendations for Pancreatic Cysts
What is the recommendation for imaging frequency for stable pancreatic cysts larger than 3 cm?
MRI alternating with EUS q year × 4 years.
p.4
Types of Pancreatic Cysts
What are some rare types of pancreatic cysts mentioned?
Simple cysts, lymphoepithelial cysts, and mucinous non-neoplastic cysts.
p.5
Diagnosis and Imaging Techniques for Pancreatic Cysts
What does a 'high' quality of evidence indicate?
Further research is unlikely to change our confidence in the estimate of the effect.
p.9
Management and Treatment Options for Pancreatic Cysts
What are the risks associated with cyst ablation?
Adverse events include fever, abdominal pain, pancreatitis, peritonitis, and thrombosis, with a reported rate of ~12%.
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the sensitivity and specificity of cyst fluid cytology for identifying IPMNs or MCNs?
Sensitivity ranges from 54% to 63% and specificity ranges from 88% to 93%.
p.2
Types of Pancreatic Cysts
What are the two broad categories of pancreatic cysts?
Neoplastic and non-neoplastic (pseudocysts).
p.9
Surveillance Recommendations for Pancreatic Cysts
What is the recommendation for cyst surveillance in asymptomatic cysts?
Cyst surveillance should be offered to surgically fit candidates with asymptomatic cysts presumed to be IPMN or MCNs.
p.1
Prevalence and Incidence of Pancreatic Cysts
What is the prevalence of pancreatic cysts larger than 2 cm?
Only 0.8% in a study of 25,195 subjects.
p.3
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is recommended regarding attributing symptoms to pancreatic cysts?
Caution is advised, as the majority of pancreatic cysts are asymptomatic and symptoms are nonspecific.
p.9
Surveillance Recommendations for Pancreatic Cysts
Which patients should undergo short-interval MRI or EUS±FNA?
Patients with IPMNs or MCNs who have new onset or worsening diabetes mellitus, or a rapid increase in cyst size (>3 mm/year).
p.5
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is recommended when attributing symptoms to a pancreatic cyst?
Caution, as the majority of pancreatic cysts are asymptomatic.
p.5
Diagnosis and Imaging Techniques for Pancreatic Cysts
What should be done if a cyst is 2-3 cm with obstructive jaundice?
EUS ± FNA and consider referral to a multidisciplinary group.
p.6
Diagnosis and Imaging Techniques for Pancreatic Cysts
What caution should be taken when using imaging to diagnose cyst type or malignancy?
The accuracy of MRI or MRCP can vary.
p.4
Risk of Malignant Transformation in Pancreatic Cysts
What is the malignancy risk associated with simple cysts and lymphoepithelial cysts?
They have no known malignancy risk.
p.4
Clinical Guidelines for Pancreatic Cyst Management
What is the significance of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology?
It determines the strength of recommendation and quality of evidence.
p.4
Risk of Malignant Transformation in Pancreatic Cysts
What distinguishes main duct IPMN from side branch IPMN?
Main duct IPMN has a higher risk of cancer.
p.8
Endoscopic Ultrasound and Cyst Fluid Analysis
What molecular markers can help identify IPMNs or MCNs?
DNA mutations in cyst fluid, particularly KRAS and GNAS mutations, have shown promise.
p.3
Surveillance Recommendations for Pancreatic Cysts
What is the preferred modality for pancreatic cyst surveillance?
MRCP, due to its lack of radiation and improved delineation of the main pancreatic duct.
p.5
Risk of Malignant Transformation in Pancreatic Cysts
What is the significance of a mural nodule or solid component in a cyst?
It indicates a high-risk characteristic for mucinous pancreatic cysts.
p.1
Prevalence and Incidence of Pancreatic Cysts
What is the reported prevalence of pancreatic cysts in an asymptomatic population?
Between 2.4% to 13.5%, increasing with age.
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the recommended action for cyst fluid cytology when imaging features are insufficient?
Cyst fluid cytology should be sent to assess for high-grade dysplasia or pancreatic cancer.
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the role of needle confocal microscopy in pancreatic cyst diagnosis?
It generates in vivo microscopic images of the cyst epithelium and has shown high specificity for differentiating cyst types.
p.5
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the role of cytology in the evaluation of pancreatic cysts?
To check for high-grade dysplasia or pancreatic cancer.
p.8
Diagnosis and Imaging Techniques for Pancreatic Cysts
What is the recommendation for cyst fluid amylase levels in diagnosing pseudocysts?
Very low levels (<250 IU/l) can exclude the presence of a pseudocyst in 98% of cases.
