Diagnosis of
pancreatic cysts remains challenging due to limitations of currently available radiologic and endoscopic tools. The diagnostic approach should focus on identifying mucinous and malignant
cysts. Mucinous
cysts require further differentiation to allow appropriate management.
RECENT FINDINGS: Although the overall rate of malignant
pancreatic cysts is low, it remains higher than the general population. MRI with magnetic resonance cholangiopancreatography is the preferred imaging modality for
pancreatic cysts. Attempts to improve diagnostic yield of endoscopic ultrasound-guided fine needle aspiration include performing
cyst wall cytology and
DNA analysis. The 2012 international consensus guidelines for mucinous
cystic neoplasm and intraductal papillary
mucinous neoplasm are superior to the original 2006 guidelines, although issues include the relatively poor ability to diagnose malignant
cysts leading to unnecessary surgeries and the de-emphasis of
cyst size.
Cyst size remains an important predictor of
malignancy. Translational research involving genomics,
microRNA, proteomics, and metabolomics holds promise for improved
biomarkers. Endoscopic innovations may safely aid in
cyst diagnosis.
SUMMARY: Incremental improvements in
pancreatic cyst diagnosis have occurred with new
biomarkers and endoscopic tools requiring validation in large-scale studies.