Pancreatic cystic lesions: classification, diagnosis and treatment

Abstract

Pancreatic cystic lesions (PCLs) are being increasingly identified in recent years. The diagnosis and discrimination of these lesions are very important because of the risk for concurrent or later development of malignancy. Pcls are usually first diagnosed in adults and characterized by conventional imaging modalities such as trans-abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). However, their ability to differentiate the benign and malignant lesions remains limited. Endoscopic US may be more helpful for the diagnosis and differentiation of PCLs because of its high resolution and better imaging characteristics than cross-sectional imaging modalities. It also allows for fine-needle aspiration (FNA) of cystic lesions is biochemical, cytological and DNA analysis that might be further helpful for diagnosis and differentiation. Owing to improvements in imaging techniques, cystic lesions of the pancreas are being identified more often, even in patients who are asymptomatic. These range from benign to premalignant lesions to highly malignant. Due to the high morbidity related to pancreatic resections, the surgeon should balance very carefully the advantages of the radical resection with the risks of an unrequested dangerous procedure. This review offers guidance on the strategies for establishing the diagnosis, assessing risk, and making difficult decisions about when surgical resection is indicated. While many CNPs have an indolent behaviour that justifies surveillance, others should be resected because of the risk of progression to invasive cancer.