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OBJECTIVE-Current generation MDCT technology facilitates identification of small, nonenhancing lesions in the pancreas. The objective of this study was to determine the prevalence of findings of unsuspected pancreatic cysts on 16-MDCT in a population of adult out-patients imaged for disease unrelated to the pancreas. MATERIALS AND METHODS-Contrast-enhancedMDCT scans of the abdomen were reviewed from 2,832 consecutive examinations to identify pancreatic cysts. Patients with a history of pancreatic lesions or predisposing factors for pancreatic disease or who were referred for pancreatic CT were excluded.RESULTS-A total of 73 patients had pancreatic cysts, representing a prevalence of 2.6 per 100 patients (95% CI, 2.0-3.2). Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm) and were solitary in 85% of cases. Analysis of demographic information showed a strong correlation between pancreatic cysts and age, with no cysts identified among patients under 40 years and a prevalence of 8.7 per 100 (95% CI, 4.6-12.9) in individuals from 80 to 89 years. After controlling for age, cysts were more common in individuals of the Asian race than all other race categories, with an odds ratio of 3.57 (95% CI, 1.05-12.13). There was no difference by sex in the prevalence of cysts (p = 0.527); however, cysts were on average 3.6 mm larger (p = 0.014) in men than women.CONCLUSION-In this outpatient population, the prevalence of unsuspected pancreatic cysts identified on 16-MDCT was 2.6%. Cyst presence strongly correlated with increasing age and the Asian race. KeywordsCT; incidence; MDCT; pancreatic cyst; prevalence This year an estimated 37,170 Americans will be diagnosed with pancreaticcancer, and 33,370 will die from the disease [1]. Detection of this disease in its early curable stages is difficult, to the extent that more than 80% of pancreatic cancers have metastasized or are locally unresectable at the time of diagnosis [2]. As a result, the 5-year survival rate for all stages combined is 5% [3]. The detection and treatment of early precursors to invasive pancreatic cancer offer the best hope for improving outcome.Address correspondence to K. M. Horton (E-mail: kmhorton@jhmi.edu). Three histologically distinct precursors to invasive adenocarcinoma of the pancreas have been identified. These include the intraductal papillary mucinous neoplasm, the mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia [4]. Pancreatic intraepithelial neoplasias are too small to be detected by most imaging methods. However, both intraductal papillary mucinous neoplasms and mucinous cystic neoplasms should be detectable, and both appear as cystic pancreatic lesions on cross-sectional imaging [5]. This suggests that an asymptomatic cyst detected in the pancreas could represent a treatable precursor to invasive cancer. NIH Public AccessA limited number of previous studies have reported both the incidence and prevalence of pancreatic cysts across a range of patient populations using autopsy, MRI, and CT [6][7][8][9]. However, curre...

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Background and aimThe International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).MethodsA modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.ResultsConsensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.ConclusionsPancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.

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