Diagnostic Approach to Incidentally Detected Pancreatic Cystic Lesions

Abstract

Purpose of review The objective of this study is to answer few key questions in order to establish the best possible available diagnostic strategy for incidentally discovered pancreatic cystic lesions (PCLs). Recent findings Advances in EUS-guided sampling techniques, cross-sectional and intracystic confocal imaging, molecular biomarkers analysis, determination of cyst fluid glucose, and artificial intelligence, appear to be associated with an improved diagnostic accuracy in distinguishing mucinous from non-mucinous PCLs. Summary The diagnostic process has the aim of recognizing cysts with malignant potential and identifying those with high-risk stigmata and/or worrisome features. Clinicians should avoid performance of unnecessary tests from one side and misdiagnosis from the other, which can easily result in inadvertent surgery of an otherwise benign lesion or malignant progression of a precancerous cyst. Clinical studies to validate recent reported results utilizing novel diagnostic tests are needed, in order to gradually incorporate and combine them into updated guidelines.

Advances in the Diagnosis of Pancreatic Cystic Lesions

“…Conversely, in another meta-analysis [ 64 ] the authors found that if cyst fluid mutational testing for KRAS/GNAS was negative, the probabilities that the patient has an IPMN or a mucinous cystic lesion would be approximately 2% and 8%, respectively [ 65 ], a finding with important practical consequences. These data have been incorporated into the last ACG clinical guideline on the diagnosis and management of pancreatic cysts, which specifically recommend molecular testing of the cyst fluid to be considered in cases in which the diagnosis is unclear, and the results are likely to change management, e.g., in the identification of IPMNs and MCNs [ 11 ].…”