Top

European Radiology

Published in:

01-06-2017 | Hepatobiliary-Pancreas

Fate of small pancreatic cysts (<3 cm) after long-term follow-up: analysis of significant radiologic characteristics and proposal of follow-up strategies

Authors: Heera Yoen, Jung Hoon Kim, Dong Ho Lee, Su Joa Ahn, Jeong Hee Yoon, Joon Koo Han

Published in: European Radiology | Issue 6/2017

Abstract

Objective

To describe the natural history of pancreatic cysts after long-term follow-up, with an emphasis on the identifying indicators of indolent lesions.

Methods

We retrospectively sampled 95 patients with 149 cysts <3 cm detected by CT from 2003 to 2004, and followed them for more than five years (mean 117.5 ± 18.8 months). Two radiologists reviewed the initial CT images, then recorded changes after the follow-up. We compared the cysts’ initial characteristics between the surgery and non-surgery patient groups, and also between non-benign lesions and benign lesions.

Results

Twelve of the 95 patients, who among them had 16 cysts, underwent surgery. Of the 133 cysts in the 83 nonsurgical patients, 57 cysts (42.9 %) enlarged, although only five cysts increased to larger than 3 cm at the end of observation. The initial size of the cyst was significantly larger in the surgery group than non-surgery group. Also, according to cyst-based analysis, ductal communication, dilatation, and shape correlated with those of non-benign cysts and the non-surgical group. No cysts < 15 mm and without p-duct change showed a significant change within three years.

Conclusion

Small pancreatic cysts, without p-duct change, and without a pleomorphic or clubbed shape, may be followed for a longer interval than current consensus.

Key Points

• Almost all small cysts < 3 cm were indolent in long term observation.

• No cysts < 15 mm, without p-duct change showed significant change within 3 years.

• Cyst size, ductal change and shape can be useful in predicting progress.

• Only cysts with IPMN- like features and p-duct change need follow-up with cautions.

Nougaret S et al (2014) Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol 24:1020–1029CrossRefPubMed

Sahani DV et al (2013) Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 200:343–354CrossRefPubMed

Handrich SJ et al (2005) The natural history of the incidentally discovered small simple pancreatic cyst: long-term follow-up and clinical implications. AJR Am J Roentgenol 184:20–23CrossRefPubMed

Brugge WR et al (2004) Cystic neoplasms of the pancreas. N Engl J Med 351:1218–1226CrossRefPubMed

Gardner TB et al (2013) Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol 108:1546–1550CrossRefPubMedPubMedCentral

Brook OR et al (2015) Delayed growth in incidental pancreatic cysts: are the current American college of radiology recommendations for follow-up appropriate? Radiology 140972

Vege SS et al (2015) American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819CrossRefPubMed

Wu BU et al (2014) Prediction of malignancy in cystic neoplasms of the pancreas: a population-based cohort study. Am J Gastroenterol 109:121–129CrossRefPubMed

Tanaka M et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32CrossRefPubMed

10.

Tanaka M et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMed

11.

Ip IK et al (2011) Focal cystic pancreatic lesions: assessing variation in radiologists’ management recommendations. Radiology 259:136–141CrossRefPubMed

12.

Lee SH et al (2007) Outcomes of cystic lesions in the pancreas after extended follow-up. Dig Dis Sci 52:2653–2659CrossRefPubMed

13.

Correa-Gallego C et al (2010) Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 10:144–150CrossRefPubMedPubMedCentral

14.

Sahani DV et al (2006) Pancreatic cysts 3 cm or smaller: how aggressive should treatment be? Radiology 238:912–919CrossRefPubMed

15.

Khannoussi W et al (2012) The long term risk of malignancy in patients with branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreatology 12:198–202CrossRefPubMed

16.

Kim SY et al (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR Am J Roentgenol 187:1192–1198CrossRefPubMed

17.

Walter TC et al (2015) Implications of imaging criteria for the management and treatment of intraductal papillary mucinous neoplasms–benign versus malignant findings. Eur Radiol 25:1329–1338CrossRefPubMed

18.

Fernandez-del Castillo C et al (2003) Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138:427-3, discussion 433-4

19.

Matsumoto T et al (2003) Optimal management of the branch duct type intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol 36:261–265CrossRefPubMed

20.

Choi BS et al (2003) Differential diagnosis of benign and malignant intraductal papillary mucinous tumors of the pancreas: MR cholangiopancreatography and MR angiography. Korean J Radiol 4:157–162CrossRefPubMedPubMedCentral

21.

Cahalane AM et al (2016) Which is the best current guideline for the diagnosis and management of cystic pancreatic neoplasms? An appraisal using evidence-based practice methods. Eur Radiol

22.

Italian Association of Hospital, G et al (2014) Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 46:479–493CrossRef

Title: Fate of small pancreatic cysts (<3 cm) after long-term follow-up: analysis of significant radiologic characteristics and proposal of follow-up strategies
Authors: Heera Yoen
Jung Hoon Kim
Dong Ho Lee
Su Joa Ahn
Jeong Hee Yoon
Joon Koo Han
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4589-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fate of small pancreatic cysts (<3 cm) after long-term follow-up: analysis of significant radiologic characteristics and proposal of follow-up strategies

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 6/2017

Contribution of mono-exponential, bi-exponential and stretched exponential model-based diffusion-weighted MR imaging in the diagnosis and differentiation of uterine cervical carcinoma

Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study

Whole brain analysis of postmortem density changes of grey and white matter on computed tomography by statistical parametric mapping

Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules

Letter to the Editor re: Should fat in the radiofrequency ablation zone of hepatocellular adenomas raise suspicion for residual tumour?

“Textural analysis of multiparametric MRI detects transition zone prostate cancer”