Prevalence of Unsuspected Pancreatic Cysts on MDCT

Abstract

OBJECTIVE-Current generation MDCT technology facilitates identification of small, nonenhancing lesions in the pancreas. The objective of this study was to determine the prevalence of findings of unsuspected pancreatic cysts on 16-MDCT in a population of adult out-patients imaged for disease unrelated to the pancreas. MATERIALS AND METHODS-Contrast-enhancedMDCT scans of the abdomen were reviewed from 2,832 consecutive examinations to identify pancreatic cysts. Patients with a history of pancreatic lesions or predisposing factors for pancreatic disease or who were referred for pancreatic CT were excluded.RESULTS-A total of 73 patients had pancreatic cysts, representing a prevalence of 2.6 per 100 patients (95% CI, 2.0-3.2). Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm) and were solitary in 85% of cases. Analysis of demographic information showed a strong correlation between pancreatic cysts and age, with no cysts identified among patients under 40 years and a prevalence of 8.7 per 100 (95% CI, 4.6-12.9) in individuals from 80 to 89 years. After controlling for age, cysts were more common in individuals of the Asian race than all other race categories, with an odds ratio of 3.57 (95% CI, 1.05-12.13). There was no difference by sex in the prevalence of cysts (p = 0.527); however, cysts were on average 3.6 mm larger (p = 0.014) in men than women.CONCLUSION-In this outpatient population, the prevalence of unsuspected pancreatic cysts identified on 16-MDCT was 2.6%. Cyst presence strongly correlated with increasing age and the Asian race. KeywordsCT; incidence; MDCT; pancreatic cyst; prevalence This year an estimated 37,170 Americans will be diagnosed with pancreaticcancer, and 33,370 will die from the disease [1]. Detection of this disease in its early curable stages is difficult, to the extent that more than 80% of pancreatic cancers have metastasized or are locally unresectable at the time of diagnosis [2]. As a result, the 5-year survival rate for all stages combined is 5% [3]. The detection and treatment of early precursors to invasive pancreatic cancer offer the best hope for improving outcome.Address correspondence to K. M. Horton (E-mail: kmhorton@jhmi.edu). Three histologically distinct precursors to invasive adenocarcinoma of the pancreas have been identified. These include the intraductal papillary mucinous neoplasm, the mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia [4]. Pancreatic intraepithelial neoplasias are too small to be detected by most imaging methods. However, both intraductal papillary mucinous neoplasms and mucinous cystic neoplasms should be detectable, and both appear as cystic pancreatic lesions on cross-sectional imaging [5]. This suggests that an asymptomatic cyst detected in the pancreas could represent a treatable precursor to invasive cancer. NIH Public AccessA limited number of previous studies have reported both the incidence and prevalence of pancreatic cysts across a range of patient populations using autopsy, MRI, and CT [6][7][8][9]. However, curre...

Prospective validation of microRNA signatures for detecting pancreatic malignant transformation in endoscopic-ultrasound guided fine-needle aspiration biopsies

“…Over the last decade, we have seen a steady rise in the incidence of pancreatic cysts, estimated to be present in ~2.4% of the population [1,2]. This is largely due to an increase in the use of cross-sectional imaging investigations undertaken for other symptoms, and an improvement in high-definition radiological techniques.…”

Integration of KRAS testing in the diagnosis of pancreatic cystic lesions: a clinical experience of 618 pancreatic cysts

“…It is reported that pancreatic cysts are identified in 1.2% to 2.6% of abdominal computed tomography scans. 1,2 The prevalence increases with age and up to 24% of patients at autopsy have pancreatic cysts. 3 Historically, pseudocysts were thought to represent the bulk of pancreatic cysts, but cystic neoplasms actually account for the majority of these lesions.…”

Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

“…Pancreatic cysts are now being discovered in large numbers of patients due to the increased use of high resolution CT and MRI diagnostic imaging, with as many as 14% of MRI scans and 3% of CT scans incidentally discovering the presence of pancreatic cysts 34–36 . Because some pancreatic cysts are precancerous, and because pancreatic cancer is such a deadly condition, diagnosing the type of pancreatic cyst lesion accurately is a high stakes challenge.…”