Digestive diseases and sciences · 2025
Identifying Neoplastic Versus Non-neoplastic Pancreatic Cystic Lesions-What Is the Current Evidence?
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Chatterjee Arjun, Prado Renan, Fulmer Clifton G, Coppa Christopher, Joyce Daniel, Mohiuddin Syed, Chahal Prabhleen, Stevens Tyler
Аннотация
BACKGROUND: The widespread use of modern, high-resolution cross-sectional imaging has led to increased detection of pancreatic cystic lesions (PCLs), which have varying malignant potential. While most require periodic radiographic surveillance, some warrant biopsy or surgical excision.
METHODS: We conducted a narrative review of the literature focusing on the diagnostic accuracy of imaging and the role of endoscopic and molecular tools in PCL evaluation.
RESULTS: Cross-sectional imaging correctly classifies cyst type based on morphological features in approximately 50% of cases, with MRI generally outperforming CT. Endoscopic ultrasonography (EUS) is particularly useful when clinical and imaging findings are inconclusive or when high-risk features are present. In selected cases, such features may prompt direct surgical intervention. EUS-guided fine-needle aspiration of cyst fluid for chemical, genetic, and cytological analysis helps differentiate neoplastic mucinous cysts-such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms-from benign, non-mucinous cysts.
CONCLUSIONS: Accurate diagnosis of PCLs requires a multimodal approach combining high-quality imaging, EUS evaluation, and cyst fluid analysis. Advances in biomarker development hold promise for improving risk stratification and guiding individualized management strategies.
METHODS: We conducted a narrative review of the literature focusing on the diagnostic accuracy of imaging and the role of endoscopic and molecular tools in PCL evaluation.
RESULTS: Cross-sectional imaging correctly classifies cyst type based on morphological features in approximately 50% of cases, with MRI generally outperforming CT. Endoscopic ultrasonography (EUS) is particularly useful when clinical and imaging findings are inconclusive or when high-risk features are present. In selected cases, such features may prompt direct surgical intervention. EUS-guided fine-needle aspiration of cyst fluid for chemical, genetic, and cytological analysis helps differentiate neoplastic mucinous cysts-such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms-from benign, non-mucinous cysts.
CONCLUSIONS: Accurate diagnosis of PCLs requires a multimodal approach combining high-quality imaging, EUS evaluation, and cyst fluid analysis. Advances in biomarker development hold promise for improving risk stratification and guiding individualized management strategies.