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Current Gastroenterology Reports
Erschienen in: Current Gastroenterology Reports 2/2010

01.04.2010

Pancreatic Cystic Lesions: When to Watch, When to Operate, and When to Ignore

verfasst von: Brian G. Turner, William R. Brugge

Erschienen in: Current Gastroenterology Reports | Ausgabe 2/2010

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Abstract

Pancreatic cystic lesions are being increasingly identified with the widespread use of state-of-the-art imaging. These lesions are categorized into a broad range of neoplastic cysts and inflammatory pseudocysts. Identification of a pancreatic cyst requires the clinician to focus on the main clinical challenge of the benign or malignant nature of the cyst. Neoplastic cysts range the spectrum from benign, to premalignant, to frank malignancy. The management of these lesions is difficult, and the decision to resect or observe a lesion is hampered by limitations in current imaging and tissue sampling techniques that prevent the accurate characterization of all lesions. This article reviews current guidelines for the evaluation of pancreatic cystic lesions, underscores the challenges posed by these lesions, and discusses current and future studies that will aid in patient management.
Literatur
1.
Laffan TA, Horton KM, Klein AP, et al.: Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008, 191:802–807.CrossRefPubMed
2.
Song SJ, Lee JM, Kim YJ, et al.: Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 2007, 26:86–93.CrossRefPubMed
3.
Brugge WR, Lauwers GY, Sahani D, et al.: Cystic neoplasms of the pancreas. N Engl J Med 2004, 351:1218–1226.CrossRefPubMed
4.
Hamilton SR, Aaltonen LA, eds: World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: International Agency for Research on Cancer (IARC) Press; 2000.
5.
Ringold DA, Shroff P, Sikka SK, et al.: Pancreatitis is frequent among patients with side-branch intraductal papillary mucinous neoplasia diagnosed by EUS. Gastrointest Endosc 2009, 70:488–494.CrossRefPubMed
6.
Sahani DV, Kadavigere R, Blake M, et al.: Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations—correlation with MRCP. Radiology 2006, 238:560–569.CrossRefPubMed
7.
Chaudhari VV, Raman SS, Vuong NL, et al.: Pancreatic cystic lesions: discrimination accuracy based on clinical data and high resolution CT features. J Comput Assist Tomogr 2007, 31:860–867.CrossRefPubMed
8.
Fisher WE, Hodges SE, Yagnik V, et al.: Accuracy of CT in predicting malignant potential of cystic pancreatic neoplasms. HPB (Oxford) 2008, 10:483–490.
9.
Gerke H, Jaffe TA, Mitchell RM, et al.: Endoscopic ultrasound and computer tomography are inaccurate methods of classifying cystic pancreatic lesions. Dig Liver Dis 2006, 38:39–44.CrossRefPubMed
10.
Procacci C, Biasiutti C, Carbognin G, et al.: Characterization of cystic tumors of the pancreas: CT accuracy. J Comput Assist Tomogr 1999, 23:906–912.CrossRefPubMed
11.
Gomez D, Rahman SH, Wong LF, et al.: Predictors of malignant potential of cystic lesions of the pancreas. Eur J Surg Oncol 2008, 34:876–882.PubMed
12.
Javle M, Shah P, Yu J, et al.: Cystic pancreatic tumors (CPT): predictors of malignant behavior. J Surg Oncol 2007, 95:221–228.CrossRefPubMed
13.
Huang ES, Turner BG, Fernandez-Del-Castillo C, et al.: Pancreatic cystic lesions: clinical predictors of malignancy in patients undergoing surgery. Aliment Pharmacol Ther 2010, 31:285–294.PubMed
14.
• Sachs T, Pratt WB, Callery MP, Vollmer CM Jr: The incidental asymptomatic pancreatic lesion: nuisance or threat? J Gastrointest Surg 2009, 13:405–415. This study reviews a large number of patients with incidentally discovered asymptomatic pancreatic lesions, both solid and cystic. It underscores support for the Sendai Guidelines with regard to management of pancreatic cysts, and alerts the clinician to the prevalence of cancer among asymptomatic pancreatic lesionsCrossRefPubMed
15.
Curry CA, Eng J, Horton KM, et al.: CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol 2000, 175:99–103.PubMed
16.
Macari M, Finn ME, Bennett GL, et al.: Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris. Radiology 2009, 251:77–84.CrossRefPubMed
17.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al.: Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004, 126:1330–1336.CrossRefPubMed
18.
• Khalid A, Zahid M, Finkelstein SD, et al.: Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc 2009, 69:1095–1102. This article reports that the presence of a k-ras mutation is indicative of a mucinous cyst and that DNA analysis can be helpful in cases of negative pancreatic cyst cytologyCrossRefPubMed
19.
Bradley EL, Clements JL Jr, Gonzalez AC: The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 1979, 137:135–141.CrossRefPubMed
20.
Cannon JW, Callery MP, Vollmer CM Jr: Diagnosis and management of pancreatic pseudocysts: what is the evidence? J Am Coll Surg 2009, 209:385–393.CrossRefPubMed
21.
Tanaka M, Chari S, Adsay V, et al.: International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006, 6:17–32.CrossRefPubMed
22.
Levy P, Jouannaud V, O'Toole D, et al.: Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 2006, 4:460–468.CrossRefPubMed
23.
Pausawasdi N, Heidt D, Kwon R, et al.: Long-term follow-up of patients with incidentally discovered pancreatic cystic neoplasms evaluated by endoscopic ultrasound. Surgery 2010, 147:13–20.CrossRefPubMed
24.
Rodriguez JR, Salvia R, Crippa S, et al.: Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 2007, 133:72–79; quiz 309–310CrossRefPubMed
25.
•• Tanno S, Nakano Y, Nishikawa T, et al.: Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 2008, 57:339–343. The authors describe an important study regarding the natural history of BDIPMNs initially diagnosed without the presence of mural nodules. Although most lesions may be observed over the long term without the development of malignant features, about 15% had notable changes that might affect patient managementCrossRefPubMed
26.
Nara S, Onaya H, Hiraoka N, et al.: Preoperative evaluation of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 2008, 57:339–343.CrossRef
27.
Huang ES, Gazelle GS, Hur C: Consensus guidelines in the management of branch duct intraductal papillary mucinous neoplasm: a cost-effectiveness analysis. Dig Dis Sci 2009 (Epub ahead of print).
28.
Das A, Ngamruengphong S, Nagendra S, Chak A: Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management. Gastrointest Endosc 2009, 70:690–699.CrossRefPubMed
29.
Sarr MG, Carpenter HA, Prabhakar LP, et al.: Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 2000, 231:205–212.CrossRefPubMed
30.
Zamboni G, Scarpa A, Bogina G, et al.: Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999, 23:410–422.CrossRefPubMed
31.
Chari ST, Yadav D, Smyrk TC, et al.: Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 2002, 123:1500–1507.CrossRefPubMed
32.
Melman L, Azar R, Beddow K, et al.: Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc 2009, 23:267–271.CrossRefPubMed
33.
Ferrone CR, Correa-Gallego C, Warshaw AL, et al.: Current trends in pancreatic cystic neoplasms. Arch Surg 2009, 144:448–454.CrossRefPubMed
34.
Nagai K, Doi R, Ito T, et al.: Single-institution validation of the international consensus guidelines for treatment of branch duct intraductal papillary mucinous neoplasms of the pancreas. J Hepatobiliary Pancreat Surg 2009, 16:353–358.CrossRefPubMed
35.
Pelaez-Luna M, Chari ST, Smyrk TC, et al.: Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol 2007, 102:1759–1764.CrossRefPubMed
36.
Sawhney MS, Al-Bashir S, Cury MS, et al.: International consensus guidelines for surgical resection of mucinous neoplasms cannot be applied to all cystic lesions of the pancreas. Clin Gastroenterol Hepatol 2009, 7:1373–1376.CrossRefPubMed
37.
Sai JK, Suyama M, Kubokawa Y, et al.: Pancreatic-duct-lavage cytology in candidates for surgical resection of branch-duct intraductal papillary mucinous neoplasm of the pancreas: should the International Consensus Guidelines be revised? Gastrointest Endosc 2009, 69(3 Pt 1):434–440.CrossRefPubMed
38.
Kanazumi N, Nakao A, Kaneko T, et al.: Surgical treatment of intraductal papillary-mucinous tumors of the pancreas. Hepatogastroenterology 2001, 48:967–971.PubMed
39.
Salvia R, Fernandez-del Castillo C, Bassi C, et al.: Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004, 239:678–685; discussion 685–677.
40.
•• DeWitt J, McGreevy K, Schmidt CM, Brugge WR: EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc 2009, 70:710–723. This article describes a randomized, double-blind study of EUS-guided ethanol lavage of pancreatic cysts compared with saline solution lavage. The results demonstrated CT-defined complete resolution in 33% of cysts and a decrease in pancreatic cyst size with the use of ethanol lavage of the cyst versus saline solution lavageCrossRefPubMed
41.
Oh HC, Seo DW, Lee TY, et al.: New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008, 67:636–642.PubMed
42.
Tang RS, Weinberg B, Dawson DW, et al.: Evaluation of the guidelines for management of pancreatic branch-duct intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol 2008, 6:815–819; quiz 719CrossRefPubMed
Metadaten
Titel
Pancreatic Cystic Lesions: When to Watch, When to Operate, and When to Ignore
verfasst von
Brian G. Turner
William R. Brugge
Publikationsdatum
01.04.2010
Verlag
Current Science Inc.
Erschienen in
Current Gastroenterology Reports / Ausgabe 2/2010
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-010-0097-0

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