What is the most common symptom in patients with symptomatic pancreatic cysts?
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Abdominal pain (69%).
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What is the most common symptom in patients with symptomatic pancreatic cysts?
Abdominal pain (69%).
What type of pancreatic tumors are usually non-functioning and rare?
Cystic pancreatic neuroendocrine tumors.
What is the role of EUS in diagnosing pancreatic cysts?
It is accurate for diagnosing benign from malignant cysts and identifying mural nodules.
What imaging technique is no longer recommended for pancreatic cyst diagnosis or surveillance?
ERCP (Endoscopic Retrograde Cholangiopancreatography).
What imaging technique improves visualization of communication between the main pancreatic duct and a pancreatic cyst?
Secretin-stimulated MRCP.
What imaging technique is often required for an accurate diagnosis of pancreatic cysts?
EUS-guided fine needle aspiration (FNA).
What is the role of EUS-FNA in the management of pancreatic cysts?
EUS-FNA is used to characterize the type of pancreatic cyst and can help differentiate between IPMNs and MCNs from other cyst types.
What is the pooled specificity and sensitivity of cytology for pancreatic cancer?
Specificity is 90.6%, while sensitivity is 64.8%.
What should be done if a pancreatic cyst shows an increase in size?
Consider shorter interval imaging with MRI or EUS ± FNA within 6 months.
What is the significance of early detection and intervention in pancreatic cysts?
It may improve survival rates for patients with high-grade dysplasia or very early pancreatic cancer.
What is the diagnostic accuracy of PET/CT compared to MDCT and MRI?
PET/CT had a diagnostic accuracy of 94%, compared to 77% for MDCT.
What is the follow-up recommendation for patients with resected serous cystadenoma or pseudocyst?
They do not require any follow-up after resection.
What are high-risk characteristics for mucinous pancreatic cysts?
Symptoms like jaundice, acute pancreatitis, elevated serum CA 19-9, and specific imaging findings.
Which patients should not undergo further evaluation of incidentally found pancreatic cysts?
Patients who are not medically fit for surgery.
What is the sensitivity of MRI for diagnosing an IPMN from other cyst types?
96%.
What is the common age range for the peak presentation of cystic pancreatic neuroendocrine tumors?
In the 60s.
What is the risk of serous cystadenocarcinoma in serous cystadenomas (SCAs)?
Extremely low at 0.1%.
What type of pancreatic cyst is most commonly resected in symptomatic cases?
Mucin-producing cysts.
What should be considered for indeterminate cysts?
A second imaging modality or cyst fluid analysis via endoscopic ultrasound (EUS).
What should be considered before starting cyst surveillance?
The patient's risk of developing pancreatic malignancy, life expectancy, comorbid conditions, and surgical candidacy.
What imaging findings warrant referral to a multidisciplinary pancreatic group?
Presence of a mural nodule, solid component, dilation of the main pancreatic duct >5 mm, or IPMNs/MCNs measuring ≥3 cm.
What should be considered when analyzing the risks posed by pancreatic cysts?
Individual life expectancy and risk of death from other factors.
What is the only viable treatment for pancreatic cysts currently?
Surgical excision.
What imaging techniques are recommended for characterizing pancreatic cysts?
MRI or magnetic resonance cholangiopancreatography (MRCP).
What must management decisions for pancreatic cysts consider?
The low risk of malignancy vs. their frequent detection.
What is the most common type of pancreatic cyst?
Intraductal papillary mucinous neoplasm (IPMN).
What is the recommendation for patients with asymptomatic cysts diagnosed as pseudocysts?
They do not require treatment or further evaluation.
How often should patients be followed after resection of a solid-pseudopapillary neoplasm?
On a yearly basis for at least 5 years.
What percentage of patients over 70 showed incidental pancreatic cysts in MRIs?
40%.
What imaging techniques are preferred for pancreatic cyst diagnosis?
Magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP) due to their non-invasiveness and accuracy.
What is recommended for patients not medically fit for surgery regarding pancreatic cysts?
They should not undergo further evaluation of incidentally found pancreatic cysts, regardless of size.
What is the risk of malignant transformation in main duct IPMNs?
38–68% harbor high-grade dysplasia or pancreatic cancer.
What is the clinical association of a pseudocyst?
Acute and/or chronic pancreatitis.
What is the typical presentation of solid-pseudopapillary neoplasms (SPNs)?
More common in women, frequently presenting in their 20s.
What are the most common presentations of pancreatic cysts?
Abdominal pain (63%) and incidental/asymptomatic (38%).
What is the mortality rate from pancreatic resection for pancreatic cysts?
2.1%.
What should be done for patients with IPMNs or MCNs showing new-onset diabetes or rapid cyst growth?
They should undergo short-interval MRI or EUS±FNA due to increased risk of malignancy.
What should be done if an asymptomatic cyst is diagnosed as a non-neoplastic cyst?
No further treatment or evaluation is warranted.
What is the current evidence regarding the routine use of cyst ablation?
There is insufficient evidence to support its routine use; it may be considered for patients who refuse or are not candidates for surgery.
What was the odds ratio indicating the association between symptoms and malignancy in pancreatic cysts?
1.6 (CI 1.0–2.6).
What is the Charlson comorbidity index (CACI) used for in patients with IPMNs?
To predict mortality based on various health conditions.
When should EUS-FNA and cyst fluid analysis be considered?
In cysts where the diagnosis is unclear and results are likely to alter management.
What is the significance of cyst fluid CEA levels in diagnosing pancreatic cysts?
Cyst fluid CEA is commonly used to identify IPMNs and MCNs, with a sensitivity of 63% and specificity of 93% at a cutoff level of 192 ng/ml.
What is the current understanding of the survival benefit of cyst surveillance?
The utility of surveillance is unproven, as there are no prospective studies determining its effect on mortality.
What challenges exist in the management of pancreatic cysts?
Contradictory recommendations due to small risk of malignant transformation and high surgical risks.
What is a key characteristic of side-branch IPMNs that MRI or MRCP can assess?
Communication between the main pancreatic duct and the cyst.
What is the accuracy of MRI or MRCP in diagnosing cyst type?
40-50% for cyst type and 55-76% for distinguishing benign from malignant.
What are the four levels of evidence used in assessing pancreatic cysts?
High, moderate, low, and very low.
What is a characteristic feature of mucinous cystic neoplasms (MCNs)?
They occur almost exclusively in women and are often found in the body or tail of the pancreas.
What is a common diagnostic tool for assessing pancreatic cysts?
Endoscopic ultrasound (EUS) with fine needle aspiration (FNA).
What is the recommended follow-up for a cyst that is ≥ 3 cm?
Refer to a multidisciplinary group and consider EUS ± FNA.
What is the overall conversion rate of pancreatic cysts to invasive cancer per year?
0.24%.
What percentage of symptomatic pancreatic cysts are reported in surgical case series?
50–84%.
What is the recommendation for imaging frequency for stable pancreatic cysts larger than 3 cm?
MRI alternating with EUS q year × 4 years.
What are some rare types of pancreatic cysts mentioned?
Simple cysts, lymphoepithelial cysts, and mucinous non-neoplastic cysts.
What does a 'high' quality of evidence indicate?
Further research is unlikely to change our confidence in the estimate of the effect.
What are the risks associated with cyst ablation?
Adverse events include fever, abdominal pain, pancreatitis, peritonitis, and thrombosis, with a reported rate of ~12%.
What is the sensitivity and specificity of cyst fluid cytology for identifying IPMNs or MCNs?
Sensitivity ranges from 54% to 63% and specificity ranges from 88% to 93%.
What is the 5-year disease-specific survival rate for pancreatic cysts?
Over 98%.
What are the two broad categories of pancreatic cysts?
Neoplastic and non-neoplastic (pseudocysts).
What imaging technique is suggested for cysts less than 1 cm?
MRI in 2 years.
What is the recommendation for cyst surveillance in asymptomatic cysts?
Cyst surveillance should be offered to surgically fit candidates with asymptomatic cysts presumed to be IPMN or MCNs.
What is the prevalence of pancreatic cysts larger than 2 cm?
Only 0.8% in a study of 25,195 subjects.
What is the cumulative incidence of pancreatic cancer at 10 years for high-risk IPMNs?
24.68%.
What is recommended regarding attributing symptoms to pancreatic cysts?
Caution is advised, as the majority of pancreatic cysts are asymptomatic and symptoms are nonspecific.
What is the accuracy of CT for identifying benign from malignant pancreatic cysts?
71–80%.
Which patients should undergo short-interval MRI or EUS±FNA?
Patients with IPMNs or MCNs who have new onset or worsening diabetes mellitus, or a rapid increase in cyst size (>3 mm/year).
What is recommended when attributing symptoms to a pancreatic cyst?
Caution, as the majority of pancreatic cysts are asymptomatic.
What should be done if a cyst is 2-3 cm with obstructive jaundice?
EUS ± FNA and consider referral to a multidisciplinary group.
What caution should be taken when using imaging to diagnose cyst type or malignancy?
The accuracy of MRI or MRCP can vary.
What is the malignancy risk associated with simple cysts and lymphoepithelial cysts?
They have no known malignancy risk.
What is the significance of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology?
It determines the strength of recommendation and quality of evidence.
What distinguishes main duct IPMN from side branch IPMN?
Main duct IPMN has a higher risk of cancer.
What molecular markers can help identify IPMNs or MCNs?
DNA mutations in cyst fluid, particularly KRAS and GNAS mutations, have shown promise.
What is the estimated probability that a pancreatic cyst harbors malignancy at the time of imaging?
0.25%.
What is the preferred modality for pancreatic cyst surveillance?
MRCP, due to its lack of radiation and improved delineation of the main pancreatic duct.
What are the most common non-neoplastic cysts associated with pancreatitis?
Pseudocysts.
What is the significance of a mural nodule or solid component in a cyst?
It indicates a high-risk characteristic for mucinous pancreatic cysts.
What does EUS stand for?
Endoscopic Ultrasound.
What is the reported prevalence of pancreatic cysts in an asymptomatic population?
Between 2.4% to 13.5%, increasing with age.
What is the recommended action for cyst fluid cytology when imaging features are insufficient?
Cyst fluid cytology should be sent to assess for high-grade dysplasia or pancreatic cancer.
What is the role of needle confocal microscopy in pancreatic cyst diagnosis?
It generates in vivo microscopic images of the cyst epithelium and has shown high specificity for differentiating cyst types.
What is the role of cytology in the evaluation of pancreatic cysts?
To check for high-grade dysplasia or pancreatic cancer.
What is the recommendation for cyst fluid amylase levels in diagnosing pseudocysts?
Very low levels (<250 IU/l) can exclude the presence of a pseudocyst in 98% of cases.
What is the incidence of high-grade dysplasia or pancreatic cancer in patients with intraductal papillary mucinous neoplasms (IPMNs) who underwent surgical resection?
42%.
