Pancreatic Cyst Prevalence and the Risk of Mucin-Producing Adenocarcinoma in US Adults

Abstract

OBJECTIVES The presence of a pancreatic cyst often prompts concern, although the rate of malignant transformation to mucin-producing adenocarcinoma is not known. We aimed to determine the prevalence rate of mucin-producing adenocarcinoma in US adults with pancreatic cysts. METHODS This retrospective, population-based cross-sectional study calculated the annual number of mucin-producing adenocarcinomas using the Surveillance Epidemiology and End Results (SEER 18) database and the 2010 United States census. The overall prevalence rate of cysts in the population was found using data from large cross-sectional imaging studies of incidental cyst prevalence. Prevalence rates were then calculated by dividing the annual number of mucin-producing adenocarcinomas by the cyst prevalence rate. RESULTS Between 2005 and 2009, 1,137 mucin-producing adenocarcinomas were estimated to be found annually in a United States adult population of 137,154,960. The total number of pancreas cysts, given a cyst prevalence rate of 2.5%, was 3,428,874. Therefore, the prevalence of mucin-producing adenocarcinoma arising in patients with pancreatic cysts was 33.2 per 100,000 (95% CI: 21.6–44.0). The prevalence rate was 32.8 per 100,000 (95% CI: 21.6–44.0) in women and 33.5 per 100,000 (95% CI: 22.2–44.8) in men. As expected, the rate of malignant transformation increased linearly with advancing age (highest 38.6 per 100,000 in 80- to 84-year old men). CONCLUSIONS Malignant transformation of pancreatic cysts into mucin-producing adenocarcinoma in US adults is a very rare event. Current clinical guidelines and resource allocation for pancreatic cyst disease should be reconsidered given these findings.

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

“…In our cohort of patients with pancreatic cysts, the incidence rate of malignant mucinous neoplasms was 0.7 per 1000 person-years. This is comparable to the reported prevalence rate of mucin-producing adenocarcinoma that arises in patients with pancreatic cysts, which is estimated to be 0.33 per 1000 patients (22). Pancreatic cysts have malignant potential, and several studies (14)(15)(16) in a Japanese population demonstrated an association between the pancreatic cysts and pancreatic ductal adenocarcinoma.…”

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.…”

Estimation of the prevalence of asymptomatic pancreatic cysts in the population of San Marino

“…There has been a dramatic increase in the number of pancreatic cysts observed in the past two decades [18]. This increase has been so impressive that, at a certain point, it was not clear whether the appearance of some cystic lesions was a new epidemic or previously overlooked disease [19].…”

“…Two studies have been considered the most scientifically rigorous as regards the prevalence of pancreatic cysts in asymptomatic patients undergoing cross-sectional imaging [18]. The first study found a rate of 2.4% in 2803 consecutive patients undergoing abdominal MRI at an institute of preventive medical care in Germany [11].…”