Pancreatic Cysts: Controversies, Advances, Diagnoses, and Therapies

Date:	2017 Jul
PMID:	28609359
Category:	2
Authors:	Jodie A Barkin 1, Jamie S Barkin
Abstract:

Pancreatic cysts are commonly found on cross-sectional imaging. The question arises in determining which lesions are premalignant or malignant and may require further testing, intervention, or follow-up. In pancreatic cysts without obvious malignancy on imaging, we approach them using the Four "S" Criteria. These are (1) symptoms that may be originating from the pancreatic cyst; (2) size of the cyst 2 cm or larger and/or main pancreatic duct greater than 5 mm; (3) survival of the patient, based on comorbidity index to determine surgical fitness; and then endoscopic ultrasound with fine needle aspiration (FNA) recommended to determine (4) solid component presence in the cyst, namely, nodule or thick walls, as well as to perform FNA to obtain cyst content. Current cyst fluid analysis options include use of cytology to determine presence of malignancy and carcinoembryonic antigen and fluid genetics to identify potentially premalignant lesions. The aims of this article are to explore current management guidelines for pancreatic cysts, present a comprehensive approach to pancreatic cysts, and explain the advantages and disadvantages of each option for evaluation of pancreatic cysts including endoscopic ultrasound with FNA with cyst fluid analysis using an evidence-based approach.

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Acknowledgements:

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institute of Health, or the National Institute of Diabetes and Digestive and Kidney Diseases.

The Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) Research Consortia is supported and funded by grants from the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases under the following award numbers:

Project Number:	Awardee Organization
U01DK108326	Baylor College of Medicine
U01DK108314	Cedars-Sinai Medical Center
U01DK108332	Indiana University
U01DK108323	Kaiser Foundation Research Institute
U01DK108288	Mayo Clinic
U01DK108327	Ohio State University
U01DK108300	Stanford University
U01DK108320	University of Florida
U01DK108306	University of Pittsburgh
U01DK108328	University of Texas MD Anderson Cancer Center