Sorting through the many recommendations on pancreatic cysts and cystic neoplasms might be confusing. Clarity is offered by a recent review article. GastroTwitter
Thankfully,
has collected this information in one place to provide practical strategies for management and surveillance.A main through-line in the various guidelines is the importance of determining the type of cyst and risks for neoplasia. There is no risk for progression with pseudocyst or serous cystadenomas, while in contrast, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms have premalignant potential for subsequent progression to cancer. Solid tumors of the pancreas may undergo cystic degeneration, and hence, have both solid and cystic components.and low carcinoembryonic antigen levels.
Endoscopic ultrasound is more invasive but is the most sensitive test for cytology and fluid analysis. However, it's typically reserved for when findings are likely to alter the management strategies.High-risk features of IPMNs include jaundice due to cyst-related biliary compression, pancreatic duct of ≥ 10 mm, mural nodule of 5 mm or solid mass, and/or cytology with high-grade dysplasia or cancer.
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