摘要
Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying riskof malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound(EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration(FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUSFNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUSguided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.
Rapid advances in radiologic technology and increasedcross-sectional imaging have led to a sharp rise inincidental discoveries of pancreatic cystic lesions.These cystic lesions include non-neoplastic cysts withno risk of malignancy, neoplastic non-mucinous serouscystadenomas with little or no risk of malignancy,as well as neoplastic mucinous cysts and solidpseudopapillary neoplasms both with varying riskof malignancy. Accurate diagnosis is imperative asmanagement is guided by symptoms and risk ofmalignancy. Endoscopic ultrasound （EUS） allows highresolution evaluation of cyst morphology and preciseguidance for fine needle aspiration （FNA） of cyst fluidfor cytological, chemical and molecular analysis. Initially,clinical evaluation and radiologic imaging, preferablywith magnetic resonance imaging of the pancreas andmagnetic resonance cholangiopancreatography, areperformed. In asymptomatic patients where diagnosisis unclear and malignant risk is indeterminate, EUSFNAshould be used to confirm the presence orabsence of high-risk features, differentiate mucinousfrom non-mucinous lesions, and diagnose malignancy.After analyzing the cyst fluid for viscosity, cyst fluidcarcinoembryonic antigen, amylase, and cyst wallcytology should be obtained. DNA analysis may adduseful information in diagnosing mucinous cystswhen the previous studies are indeterminate. Newmolecular biomarkers are being investigated to improvediagnostic capabilities and management decisions inthese challenging cystic lesions. Current guidelinesrecommend surgical pancreatic resection as thestandard of care for symptomatic cysts and those withhigh-risk features associated with malignancy. EUSguidedcyst ablation is a promising minimally invasive,relatively low-risk alternative to both surgery andsurveillance.
