Incidental Pancreatic Cystic Lesions: Is There a Relationship with the Development of Pancreatic Adenocarcinoma and All-Cause Mortality?

Abstract

Purpose:To establish the effect of incidental pancreatic cysts found by using computed tomographic (CT) and magnetic resonance (MR) imaging on the incidence of pancreatic ductal adenocarcinoma and overall mortality in patients from an inner-city urban U.S. tertiary care medical center. Materials and Methods:Institutional review board granted approval for the study and waived the informed consent requirement. The study population comprised cyst and no-cyst cohorts drawn from all adults who underwent abdominal CT and/or MR November 1, 2001, to November 1, 2011. Cyst cohort included patients whose CT or MR imaging showed incidental pancreatic cysts; no-cyst cohort was three-to-one frequency matched by age decade, imaging modality, and year of initial study from the pool without reported incidental pancreatic cysts. Patients with pancreatic cancer diagnosed within 5 years before initial CT or MR were excluded. Demographics, study location (outpatient, inpatient, or emergency department), dates of pancreatic adenocarcinoma and death, and modified Charlson scores within 3 months before initial CT or MR examination were extracted from the hospital database. Cox hazard models were constructed; incident pancreatic adenocarcinoma and mortality were outcome events. Adenocarcinomas diagnosed 6 months or longer after initial CT or MR examination were considered incident. Results:There were 2034 patients in cyst cohort (1326 Conclusion:Incidental pancreatic cysts found by using CT or MR imaging are associated with increased mortality for patients younger than 65 years and an overall increased risk of pancreatic adenocarcinoma.q RSNA, 2014

Pancreatic cysts: What imaging characteristics are associated with development of pancreatic ductal adenocarcinoma?

“…Additionally, several studies have demonstrated an association between pancreatic cysts and pancreatic ductal adenocarcinoma [7,[9][10][11][12]. Our results are in concordance with the literature, demonstrating 2.83 times higher odds of PDAC in patients with pancreatic cysts than in those without pancreatic cysts.…”

“…Chernyak et al previously showed in a large retrospective cohort study that the majority of pancreatic adenocarcinomas that developed in patients with pre-existing pancreatic cysts occurred in a location different from the original cyst [7]. In addition, Bartsch et al demonstrated that in patients with familial pancreatic cancer, small intraductal papillary mucinous neoplasms are associated with the presence of high-grade pancreatic intraepithelial neoplasia (a precursor to adenocarcinoma) elsewhere in the pancreas [16].…”

“…Despite this established association between pancreatic cysts and PDAC, the incidence of PDAC in patients with pancreatic cysts remains very small: in patients with incidental pancreatic cysts, the 10-year cumulative incidence of PDAC was 1.5% and incidence rate of PDAC was 1.8 per 1,000 person-years [7]. Therefore, aggressive followup of all patients may not prove to be cost-effective, particularly in the older population where the presence of pancreatic cysts is not associated with increased mortality [7].…”

“…Studies have demonstrated a low rate of cyst-related malignancy in cysts under 3 cm [4][5][6]. Several studies to date have demonstrated an association between pancreatic cysts and pancreatic ductal adenocarcinoma (PDAC) [7].…”

Appropriate Interval for Imaging Follow-up of Small Simple Pancreatic Cysts

“…This finding concurs with the results of a recent large study of 2034 patients with pancreatic cysts and 6018 patients without pancreatic cysts in whom the presence of at least 1 pancreatic cystic lesion resulted in a 3-fold higher probability of pancreatic adenocarcinoma. 12 A retrospective cohort study of adult patients with pancreatic cysts evident on medical record review found that patients could be stratified into low-, intermediate-, and high-risk categories on the basis of 4 cross-sectional imaging features: size, pancreatic duct dilation, septations with calcifications, and growth. 13 Patients with cysts 2 cm or less with no other suspicious imaging features have a very low probability of malignancy developing (≤ 0.6%), whereas these authors suggest that patients with cysts sized 1 cm to 3 cm that also have at least 1 suspicious imaging characteristic deserve close surveillance.…”