Abstract
Pancreatic cyst diagnosis remains a challenge. The present algorithm was based on recent international guidelines and provides a practical overview of diagnostic sequence. We firstly divided cysts into “incidentally detected” and “symptomatic,” trying to highlight the indications to follow-up, surgery, or EUS.
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Keywords
∗Gadolinium-enhanced MRI with MRCP (preferred) and/or pancreatic protocol CE-CT
∗∗Communication with pancreatic ducts, multifocality, bunch of grapes morphology
∗∗∗Lobulated honeycomb shape ± central scar/calcification
∗∗∗∗Consider a first close follow-up for the risk of retention cyst in isodense pancreatic cancer
∗Solid mass, enhancing mural nodule ≥5 mm, MPD ≥10 mm
∗∗Enhancing mural nodule <5 mm, MPD 5–9 mm; thickened/enhancing wall, abrupt change in caliber of MPD with distal atrophy; lymphadenopathy; new onset of diabetes mellitus; CA 19-9 ≥37 U/mL; grow rate ≥5 mm/year (or 2 years, depending on evaluated guideline); cyst size ≥30 mm (or 40 mm, depending on evaluated guideline)
∗∗∗MPD thickened wall/nodule or intraductal mucin
∗Evaluate the relation between the presence of the cyst and the onset of pancreatitis (i.e., was the cyst already present at the time of AP?) and the cyst morphology
∗∗Symptoms (mass effect, vomiting, jaundice, abdominal pain), sign of infection, or increasing size
Abbreviations
- AP:
-
Acute pancreatitis
- BD-IPMN:
-
Branch-duct intraductal papillary mucinous neoplasm
- CE-CT:
-
Contrast-enhanced computed tomography
- CE-EUS:
-
Contrast-enhanced endoscopic ultrasound
- EUS:
-
Endoscopic ultrasound
- HGD:
-
High-grade dysplasia
- IPMN:
-
Intraductal papillary mucinous neoplasm
- MCN:
-
Mucinous cystic neoplasm
- MPD:
-
Main pancreatic duct
- MRCP:
-
Magnetic resonance cholangiopancreatography
- MRI:
-
Magnetic resonance imaging
- NET:
-
Neuroendocrine Tumor
- RP:
-
Recurrent pancreatitis
- SCA:
-
Serous cystadenoma
- SPN:
-
Solid pseudopapillary neoplasm
- TA:
-
Tissue acquisition (fluid cytology, cyst wall fine-needle aspiration/biopsy, through-the-needle biopsy)
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Crinò, S.F. (2020). Diagnosis of Pancreatic Cyst: Algorithm. In: Mutignani, M., Albert, J.G., Fabbri, C. (eds) Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS. Springer, Cham. https://doi.org/10.1007/978-3-030-42569-2_57
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DOI: https://doi.org/10.1007/978-3-030-42569-2_57
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