Overview and comparison of guidelines for management of pancreatic cystic neoplasms

Abstract

Pancreatic cysts are identified at an increasing frequency. Although mucinous cystic neoplasms represent a pre-malignant condition, the majority of these lesions do not progress to cancer. Over the last 10 years several societies have established guidelines for the diagnosis, initial evaluation and surveillance of these lesions. Here we provide an overview of five commonly used guidelines: 2015 American Gastroenterological Association, 2017 International Association of Pancreatology, American College of Gastroenterology 2018, European Study Group and American College of Radiology. We describe the similarities and differences between the methods used to formulate these guidelines, the population they target and their approaches towards initial evaluation and surveillance of cystic lesions.

CT-Based Radiomics Analysis to Predict Malignancy in Patients with Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

“…Despite these improvements, the most recent International Consensus Guidelines (ICG) continue to contribute to unnecessary pancreatic resections because morphologic imaging features on CT and/or MRI are still inaccurate for assessing dysplasia [14,16,17]. A multi-institutional study by Wilson et al, which included 324 patients, found that only 44% of the specimens resected had LGD [18].…”

Diagnostic approaches for pancreatic cystic lesions

“…However, they do not consider solid papillary neoplasms, neuroendocrine tumours and main duct IPMN without branch duct involvement. 23 Like the IAP consensus guidelines, they also recommended surgical resection for main duct and mixed main and branch duct IPMNs and MCNs. However, they differed from the Sendai and Fukuoka guidelines in that the AGA algorithm incorporates all other PCLs in addition to branch duct IPMNs.…”

“…27 They target those patients found incidentally to have PCLs but lack a strong family history and genetic mutations which may result in pancreatic cancer. 23 These guidelines are unique in their diagnosis and management of serous cystadenomas and pseudocysts and their recommendations for surveillance cessation. 23,27 Recent diagnostic advances Endoscopic ultrasound and cyst fluid analysis EUS is generally considered the most sensitive diagnostic modality for malignant PCLs.…”

“…23 These guidelines are unique in their diagnosis and management of serous cystadenomas and pseudocysts and their recommendations for surveillance cessation. 23,27 Recent diagnostic advances Endoscopic ultrasound and cyst fluid analysis EUS is generally considered the most sensitive diagnostic modality for malignant PCLs. 28 Du et al demonstrated the superiority of EUS over CT and MRI imaging in differentiating neoplastic from non-neoplastic PCLs and characterizing PCNs.…”

Neoplasia Quística Mucinosa Gigante del Páncreas Tratada con Pancreatectomía Corporocaudal y Preservación Esplénica

“…La neoplasia quística mucinosa del páncreas (NQMP) es un tumor infrecuente, que afecta predominantemente a mujeres (90-95 %), afectando especialmente entre la quinta y séptima década de la vida; cuyo descubrimiento suele ser incidental por cortes imagenológicos del abdomen. Por lo general, son lesiones solitarias, sin compromiso del conducto pancreático principal; poco sintomáticas y asociadas a malignidad en un 10 a 40 % de los casos, dependiendo en especial de su tamaño (Jorba et al, 2008;Troncoso et al, 2015;Burk et al, 2018; European Study Group on Cystic Tumours of the Pancreas, 2018;van Huijgevoort et al, 2019;Hurtado-Pardo et al, 2019;Hasan et al, 2019).…”