Evaluation and management of pancreatic cysts

MRI: magnetic resonance imaging; MRCP: magnetic resonance cholangiopancreatography; IPMN: intraductal pancreatic mucinous neoplasm; SPN: solid pseudopapillary neoplasm; MCN: mucinous cystic neoplasm; EUS-FNA: endoscopic ultrasound-guided fine-needle aspiration; CEA: carcinoembryonic antigen.
* A pancreatic protocol computed tomography scan is an alternative for patients who cannot undergo MRI.
¶ Refer to UpToDate topics on the evaluation of pancreatic cystic neoplasms for details on the specific features needed to make a diagnosis.
Δ The decision to recommend surgery should take into account factors such as the patient's age and general health, the malignant risk of the specific lesion, and the suspicion for malignancy.
◊ Surveillance should be considered because these cysts, despite being small, may be precancerous. The decision to pursue surveillance should take into account factors such as the patient's age, comorbidities, and willingness to undergo surgery if worrisome features develop.
§ Cyst fluid should be tested for cytology; CEA level; and the molecular markers KRAS, GNAS, VHL, CTNNB1, TP53, P1K3CA, and PTEN. KRAS and GNAS have been associated with IPMNs and MCNs, and GNAS appears to be highly specific for IPMN. TP53, PIK3CA, and PTEN have been associated with high-grade dysplasia or invasive carcinoma in patients with IPMN. VHL is seen in serous cystic tumors, whereas CTNNB1 is seen in SPNs.
¥ Refer to UpToDate topic on the management of IPMNs for details.
‡ Refer to UpToDate content on the management of pancreatic cysts for details.