Dataset Information

Pancreatic Cystic Neoplasms: Diagnosis and Management.

ABSTRACT: Pancreatic cancer is one of the most lethal cancers, largely related to the difficulties with early detection, as it typically presents in later stages. Pancreatic cystic neoplasms (PCN) are commonly diagnosed as incidental findings on routine imaging. PCN is becoming more frequently detected with the increasing ease and frequency of obtaining cross-sectional images. Certain subtypes of pancreatic cysts have the potential to progress to malignancy, and therefore, clinicians are tasked with creating a patient-centered management plan. The decision of whether to undergo surgical resection or interval surveillance can be challenging given the criteria, including PCN size, pancreatic duct dilation, presence of a mural nodule, and clinical symptoms that play a potential role in risk stratification. Furthermore, the guidelines available from the major gastrointestinal societies all differ in their management recommendations. In this review, we detail an overview of the different types of PCNs and compare major guidelines for both diagnosis and management. We include emerging evidence for next-generation sequencing as well as confocal needle endomicroscopy to aid in the diagnosis and determination of malignancy potential and diagnosis.

SUBMITTER: Schubach A

PROVIDER: S-EPMC9857870 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Pancreatic Cystic Neoplasms: Diagnosis and Management.

Schubach Abigail A Kothari Shivangi S Kothari Truptesh T

Diagnostics (Basel, Switzerland) 20230105 2

Pancreatic cancer is one of the most lethal cancers, largely related to the difficulties with early detection, as it typically presents in later stages. Pancreatic cystic neoplasms (PCN) are commonly diagnosed as incidental findings on routine imaging. PCN is becoming more frequently detected with the increasing ease and frequency of obtaining cross-sectional images. Certain subtypes of pancreatic cysts have the potential to progress to malignancy, and therefore, clinicians are tasked with creat ...[more]

PMID: 36673017

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Project description:ObjectiveTo survey experts' opinions in abdominal radiology (radiologists) and pancreas-specialized gastroenterology (pancreatologists) in South Korea regarding diagnosing and managing pancreatic cystic neoplasms (PCNs).Materials and methodsBetween August 25, 2023, and October 5, 2023, an online survey was conducted among members of the Korean Society of Abdominal Radiology and the Korean Pancreatobiliary Association via email invitation.ResultsThe responses from 100 radiologists and 41 pancreatologists were analyzed. Of the respondents, 55.3% (78/141) reported seeing more than 50 patients or reading more than 50 exams related to PCN each month. The most common and preferred diagnostic modality for PCN was contrast-enhanced computed tomography (CECT), favored by 87.8% (36/41) of pancreatologists. When discrepancies arose between CECT or magnetic resonance imaging (MRI) and endoscopic ultrasound, 31.2% (44/141) of the respondents opted for multidisciplinary team discussion, whereas 29.1% (41/141) chose short-term follow-up using CECT or MRI. A total of 88.7% (125/141) of the respondents adhered to the 2017 International Association of Pancreatology (IAP) guidelines in their practice. Among the radiologists, 51.0% (51/100) endorsed a cut-off value of 5 mm for enhancing mural nodules, and 22.0% (22/100) supported a 5 mm/2 yr growth rate in the IAP guidelines v.2017. Additionally, 73.0% (73/100) of radiologists favored discontinuing surveillance, whereas 41.5% (17/41) of pancreatologists disagreed with stopping surveillance.ConclusionThe survey underscores the clinical burden PCN poses and identifies CECT as the foremost diagnostic tool. Variability was noted in the terminology, differential diagnosis, approaches for resolving discrepancies between imaging examinations, and opinions on surveillance discontinuation among the respondents as a whole, as well as between radiologists and pancreatologists. Although the 2017 IAP guidelines are primarily followed, there remains a level of dissatisfaction with risk stratification among radiologists. This highlights the need for more standardized diagnostic algorithms and improved consensus among specialists to address these challenges.

Project description:BackgroundAdvances in imaging have improved the detection rate of pancreatic cystic neoplasms (PCNs), but clinical management varies depending on the pathological type of PCNs, and thus accurate differential diagnosis is of considerable clinical significance. We conducted this study to identify the clinical and sonographic features of PCNs with significance for differential diagnosis and to compare the diagnostic accuracy of conventional ultrasound and conventional ultrasound combined with contrast-enhanced ultrasound (CEUS) for PCNs.MethodsFrom January 1, 2011, to December 31, 2022, a total of 100 patients with PCNs who underwent CEUS examination and were confirmed to have PCNs by postoperative pathology in West China Hospital of Sichuan University were included in this study.ResultsOf the clinical characteristics of PCNs, age and gender were found to be important differential diagnostic features. Moreover, communication of the lesion with the main pancreatic duct on conventional ultrasound and CEUS images was a critical feature in the differential diagnosis of intraductal papillary mucinous neoplasm (IPMN). The size of the lesion, the thickness of the cyst wall and the number of septa in conventional ultrasound images, the uniformity of the cyst wall thickness in CEUS images, and the enhancement pattern in the arterial phase were significant features for the differential diagnosis of serous cystic neoplasm (SCN). Cyst wall thickness and uniformity of the cyst wall thickness in conventional ultrasound images and cyst wall thickness and septa thickness in CEUS images were important features in the differential diagnosis of mucinous cystic neoplasm (MCN). The size and internal components of the lesion on conventional ultrasound images, internal components of the lesion, and the enhancement pattern in the arterial phase and rim enhancement on CEUS images were the key features in the differential diagnosis of solid pseudopapillary neoplasm (SPN). Conventional ultrasound combined with CEUS demonstrated significantly greater accuracy than did conventional ultrasound alone in the differential diagnosis of PCNs (66% vs. 79%; P=0.002).ConclusionsPCN types differ in their clinical and ultrasound features. Conventional ultrasound combined with CEUS can better distinguish between different pathological types of PCNs than can conventional ultrasound alone.

Dataset Information

Pancreatic Cystic Neoplasms: Diagnosis and Management.

Publications

Pancreatic Cystic Neoplasms: Diagnosis and Management.

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