Prevalence of Incidental Pancreatic Cysts in the Adult Population on MR Imaging
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. The American Journal of Gastroenterology
(Impact Factor: 10.76).
03/2010; 105(9):2079-84. DOI: 10.1038/ajg.2010.122
The reporting of incidental pancreatic cystic lesions on cross-sectional imaging studies has dramatically increased over the last few years. The prevalence of incidental pancreatic cysts in the adult population, however, is unknown. The aim of our study was to determine the prevalence of incidentally detected pancreatic cysts in the adult population undergoing abdominal magnetic resonance (MR) imaging.
MR imaging examinations of 616 consecutive patients obtained between January 2001 and February 2002 were retrospectively reviewed by two radiologists and the following information was recorded: the total number of pancreatic cysts; the maximum diameter, location, and characteristics of the largest cyst; documentation of the cyst(s) within the radiology report; and characteristics of the cyst(s) at imaging follow-up.
Incidental pancreatic cysts were present in 13.5% (83/616) of patients, with 60% of the cysts being solitary, and 88% of the cysts being simple. Largest cyst mean and median diameters were 7.4 mm (2-24 mm) and 6 mm, respectively. Both the prevalence of pancreatic cysts and the mean size of the largest cyst increased with age (P=0.007, r=0.893 and P=0.003, r=0.929, respectively). Only 31% (26/83) of incidental pancreatic cysts were documented in the radiology report. The mean size of reported pancreatic cysts was larger than those cysts that were not reported (P<0.001).
The prevalence of incidentally detected pancreatic cysts on MR imaging is 13.5%, and increases with age. A majority of these cysts are not reported on MR imaging studies.
Available from: Longyun Ye
- "This is similar to Western series such as the United States, in which cross sectional imaging has been used extensively for a longer period of time. In the Western series it has been reported that 2.6% of patients undergoing an abdominal CT scan are found to have a cystic neoplasm and another study reports 13% of patients undergoing abdominal MRI scans have cystic neoplasms [1-4]. The incidence of pancreatic cystic lesions is about 1 in 100 hospitalized patients in the United States . "
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To investigate the clinicopathological features of surgically resected pancreatic cystic neoplasms (PCNs) at a single institution in China.
The medical charts of patients who operated in the Second Affiliated Hospital, Zhejiang University School of Medicine between 1 January 1997 and 30 June 2013, were pathologically shown to have PCNs.
There was a reliable increase trend not just in the overall number of patients (3 to 75) but additionally in the number of incidentally diagnosed patients across the periods (33.3% to 48.0%). In 83 of 111 cases, preoperative diagnoses matched with pathology, whereas the remaining cases (16/28) were misdiagnosed as pancreatic cancer. The proportion of malignancy in mucin producing neoplasms was 24.3% (9 out of 37). Elevated serum carbohydrate antigen (CA19-9) or carcinoembryonic antigen (CEA) was independently associated with malignancy. The overall survival rate was 96.4%.
The proportion of PCNs within this series differs with that revealed in Western countries. Appropriate preoperative differential diagnosing of PCNs remains challenging. It is strongly recommended that patients with elevated CA19-9 or CEA levels undergo surgical resection.
Available from: Claudio Pasquali
- "The size and number of CPNs (per patient) also increase with age   . Of note, a non-negligible proportion of CPNs, especially those with small diameters, are usually not described in imaging reports in patients without a past history of pancreatic disease (69% of cystic lesions with a mean diameter of 6 mm were not reported) . While there is now an increased awareness of these lesions, their natural history is still partially unclear, and optimal management is still under debate. "
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ABSTRACT: This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
- "Compared with CT, MRI and specifically the T2-weighted imaging, has inherently superior soft tissue contrast and effectiveness in highlighting fluid-containing structures. It has a better ability to demonstrate communication between the cystic lesion and the main pancreatic duct (PD) compared to CT and the added benefit of not using ionizing radiation. "
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ABSTRACT: Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is an established diagnostic tool in the management of pancreatic cystic lesions (PCLs). Due to the proximity to the target lesion, the fine diagnostic needle travels through only minimal normal tissues. The risks of bleeding, pancreatitis and infection are small. Valuable diagnostic morphological information can be obtained by EUS before the use of FNA. The additional cytopathologic and cyst fluid analysis for the conventional markers such as amylase, carcinoembryonic antigen (CEA) and CA19.9 improves the diagnostic capability. Pancreatic cyst fluid CEA concentration of 192 ng/mL is generally the most agreed cutoff to differentiate mucinous from non-mucinous lesion. A fluid amylase level of <250 IU/L excludes the diagnosis of pseudocyst. Technical tips of EUS-FNA and the limitations of the procedure are discussed. Promising technique and FNA needle modifications have been described to improve the diagnostic yield at the cytopathologic analysis. The use of novel cyst fluid proteomics and deoxyribonucleic acid-based biomarkers of the PCLs are reviewed. Although it is considered a safe procedure, EUS-FNA is not a routine in every patient. Recommendations of the role of EUS-FNA at various common clinical scenarios are discussed.
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