Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature

Nilsson, Linda; Keane, M. G.; Shamali, Awad; Bocos, Judith Millastre; Zanten, Monica Marijinissen Van; Antila, Anne; Gil, Cristina Verdejo; Chiaro, Marco Del; Laukkarinen, Johanna

doi:10.1016/j.pan.2016.09.011

Cited by 107 publications

(93 citation statements)

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“…Since the first case reported by Aparicio et al, [9] in 2010, many case reports have been published [11,[25][26][27][28][29][30]. We collected data from eight studies, with the first published in 2018, overall including 423 patients.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

et al. 2020

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Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

et al. 2020

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“…If the size is over 40 mm, then surgical resection is mandatory. Surgical resection is also required if MCN is symptomatic or if there is a mural nodule, irrespective of the size [76]. However, the size of MCN needs to be monitored; some evidence suggests that there is rapid growth of the MCN during pregnancy and that the chances of rupture also increase [77].…”

Section: Mucinous Cystic Neoplasm (Mcn)mentioning

confidence: 99%

An updated review of pancreatic cystic lesions

Muralidharan¹,

Raj²,

Nathala³

2019

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A pancreatic cystic lesion (PCL) is a collection of fluid in the pancreas, which is often diagnosed incidentally during abdominal imaging, and often poses a diagnostic and therapeutic challenge. PCLs not only have diverse histological and imaging appearances but also differ in clinical presentation, biologic behaviour, growth pattern, and risk of malignancy. Apart from their diagnosis, the management of PCL is also multifactorial, which takes into consideration risk of malignancy, cost of cyst analysis, cyst surveillance, anatomic location of the cyst, the patient's age, and overall health status. Although guidelines exist for surgical and conservative management, each case needs to be tailored to malignant risk, surgical risk, and life expectancy in mind. This would thereby reduce both the monetary and non-monetary burden on patients. In this review, we aim to provide insight into the various recent advances in the diagnosis and management of PCL. Streszczenie Zmiana torbielowata w trzustce (PCL) to zbiornik płynu, który często jest diagnozowany przypadkowo podczas obrazowania jamy brzusznej. Nierzadko stanowi on wyzwanie diagnostyczne i terapeutyczne. Zmiany torbielowate różnią się między sobą wynikami badań histologicznych i obrazowych, a także obrazem klinicznym, cechami biologicznymi, wzorcem wzrostu i ryzykiem nowotworu. Postępowanie w PCL jest wieloczynnikowe, uwzględnia ryzyko złośliwości, koszty analizy torbieli, kontrolę nad torbielą, jej lokalizację anatomiczną, wiek i ogólny stan zdrowia pacjenta. Chociaż istnieją wytyczne dotyczące postępowania chirurgicznego i zachowawczego, każdy przypadek musi być rozpatrywany indywidualnie z uwzględnieniem ryzyka złośliwości, ryzyka chirurgicznego i średniej długości życia. W ten sposób zmniejszyłoby się obciążenie pacjentów-zarówno finansowe, jak i innego rodzaju. Autorzy przedstawiają najnowsze informacje dotyczące postępów w diagnostyce i leczeniu PCL.

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“…IPMN is often diagnosed around the age of 60 years, with equal incidence in women and men. MCN, accounting for 2-5% of all exocrine pancreas neoplasms, are mostly diagnosed at the age of 40-60 years and almost exclusively in women (95%) [17]. SPN are often diagnosed in young patients (20-30 years), with a higher incidence among women.…”

Section: Epidemiologymentioning

confidence: 99%

“…There is no connection between the cyst and the pancreatic duct. Several characteristics, such as cyst size and mural nodules, are associated with the grade of malignancy [17,22,23]. The recent European guideline is the first to highlight the low risk of malignancy when MCN are smaller than 40 mm [6].…”

Section: Radiologymentioning

confidence: 99%

Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines

et al. 2018

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Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behavior. The most prevalent PCN are intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN). Management of PCN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multidisciplinary PCN teams. The malignant potential of PCN varies enormously between the various types of PCN. A combination of computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, and endoscopic ultrasound with or without fine needle aspiration is typically needed before a reliable diagnosis can be made. Several guidelines discuss the management of PCN; however, most of these are non-evidence-based without clear consensus on the optimal treatment and follow-up strategy. The 2018 European guidelines on PCN are the first evidence-based guidelines to include IPMN, MCN, SCN, and all other PCN. This guideline advises a more conservative approach to side-branch IPMN and MCN smaller than 40 mm and more often a surgical approach in IPMN with a main duct dilatation beyond 5 mm. The goal of this review is to summarize the different types and management of the most common PCN based on the current literature and guidelines.

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Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature

Cited by 107 publications

References 64 publications

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

An updated review of pancreatic cystic lesions

Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines

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