Evaluation and Management of Pancreatic Cystic Lesions

Malignancy associated with these cysts is very rare, with the largest cohort study reporting a rate of 0.1% [10]. The diagnosis can commonly be made by its unique imaging appearance [10]. Diagnostic biomarkers that may identify such cysts with more certainty are under active investigation [77]. Resection is reasonable and often performed for SCNs when they cause debilitating symptoms including refractory abdominal pain or pancreatitis. When resected and confirmed by pathology, no surveillance is required [14,78].

Conclusion

Pancreatic cysts are common incidental findings in clinical practice today. Many cause anxiety due to their association with pancreas cancer, but most are indolent and safe to observe. Even those cysts with malignant potential grow slowly and immediate surgery is often unnecessary. Several guidelines have been developed, and while there are similarities between them, there are enough critical differences unfortunately to cause some confusion among practitioners today. Further robust research is needed to help address and reconcile these differences. In the meantime, a multidisciplinary approach is highly recommended at dedicated centers of excellence for pancreatic diseases.

Corresponding author: Walter G. Park, MD, MS, 300 Pasteur Drive, MC: 5187, Stanford, CA 94305, wgpark@stanford.edu.

Funding/support: Dr. Park is funded by an American College of Gastroenterology Junior Faculty Development Award and is a subcontinent for the National Cancer Institute's Early Detection Research Network.

Financial disclosures: None.

Author contributions: conception and design, TZ, WGP; analysis and interpretation of data, WGP; drafting of article, TZ, WGP; critical revision of the article, TZ, WGP.