scholarly journals Interdisciplinary Management of Cystic Neoplasms of the Pancreas

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Linda S. Lee ◽  
Thomas Clancy ◽  
Vivek Kadiyala ◽  
Shadeah Suleiman ◽  
Darwin L. Conwell
Keyword(s):  
Wide Spectrum ◽  
Interdisciplinary Approach ◽  
Premalignant Lesions ◽  
Pancreatic Cysts ◽  
Interdisciplinary Management ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Frequent Use ◽  
Pancreatic Cystic Neoplasms ◽  
Pathologic Analysis

Cystic neoplasms of the pancreas are increasingly recognized due to the frequent use of abdominal imaging. It is reported that up to 20% of abdominal cross-sectional scans identify incidental asymptomatic pancreatic cysts. Proper characterization of pancreatic cystic neoplasms is important not only to recognize premalignant lesions that will require surgical resection, but also to allow nonoperative management of many cystic lesions that will not require resection with its inherent morbidity. Though reliable biomarkers are lacking, a wide spectrum of diagnostic modalities are available to evaluate pancreatic cystic neoplasms, including radiologic, endoscopic, laboratory, and pathologic analysis. An interdisciplinary approach to management of these lesions which incorporates recent, specialty-specific advances in the medical literature is herein suggested.

scholarly journals Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk

2018 ◽  
Vol 51 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Aline Falqueto ◽  
Gustavo Lemos Pelandré ◽  
Mariânges Zadrozny Gouvêa da Costa ◽  
Marcelo Souto Nacif ◽  
Edson Marchiori
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Pancreatic Cysts ◽  
Resonance Imaging ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Malignancy Risk ◽  
Pancreatic Cystic Neoplasms

Abstract Objective: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. Materials and methods: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. Results: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. Conclusion: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

Determining when endoscopic ultrasound (EUS) changes management for patients with pancreatic cystic neoplasms.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 641-641
Author(s):  
Hasrit Sidhu ◽  
Khaola Maher ◽  
Dave Farnell ◽  
Leo Chen ◽  
Ian Gan ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Management ◽  
High Specificity ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Pancreatic Cystic Neoplasms ◽  
Low Sensitivity ◽  
Ct And Mri

641 Background: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to the widespread use of CT and MRI. CT and MRI cannot always differentiate between malignant and benign PCNs. EUS is an emerging tool that provides higher quality descriptions of pancreatic cysts and can be used to differentiate between benign and malignant features. Considering that EUS is a resource dependent tool, we hope to identify the PCN cases in which EUS changes management. Methods: We conducted a retrospective case-control chart review evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS for analysis between January 1, 2010 and December 31, 2017. We determined whether EUS correctly identified high-risk features (HRFs) relative to CT/MRI and whether EUS upstaged or downstaged the CT/MRI diagnosis to change overall patient management. Results: EUS was found to have a high specificity (> 95%) for all high-risk features identified in the AGA and FG guidelines and a low sensitivity ( < 70%) for all high risk features except cyst size > 3cm (82.35%) and mural nodule < 5mm (100%). EUS was found to change management in 29.4% of cases (18.2% upstaged, 11.2% downstaged). EUS screening led to a total of three adenocarcinoma diagnoses, in which two were reported to be invasive. Conclusions: The high specificity of EUS supports its use in the differentiation of high risk PCNs identified on cross-sectional imaging. Its low sensitivity indicates that the reliance on operator experience may be a substantial limitation resulting in inconclusive diagnoses. In conclusion, considering that EUS is successful in changing patient management of PCNs, it should be readily referred when any HRF is identified on cross-sectional imaging.

scholarly journals Pancreatic Cysts

2016 ◽  
Vol 46 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Timothy Meagher ◽  
Andreas Armuss
Keyword(s):  
Malignant Transformation ◽  
Abdominal Imaging ◽  
The Other ◽  
Pancreatic Cysts ◽  
Risk Selection ◽  
Optimal Management ◽  
Ongoing Debate ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms ◽  
Benign Course

Pancreatic cysts are more common than before, largely because of widespread abdominal imaging. Pancreatic cystic neoplasms (PCN) are relevant to risk selection on 2 counts: they constitute more than 50% of all pancreatic cysts and, in contrast to the other 2 cyst types, are capable of malignant transformation. The majority of PCNs are benign at time of diagnosis and will follow a benign course. The challenge is to identify those PCNs that are malignant or will undergo malignant transformation with time. The purpose of this article is to provide pointers that can help meet this challenge while also summarizing the ongoing debate about their optimal management.

scholarly journals Survival in Cystic Neoplasms of the Pancreas

2009 ◽  
Vol 23 (8) ◽  
pp. 537-542 ◽  
Author(s):  
Ali Cadili ◽  
Amy Bazzerelli ◽  
Sipi Garg ◽  
Robert Bailey
Keyword(s):  
Overall Survival ◽  
Pancreatic Cyst ◽  
Patient Survival ◽  
Survival Rates ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Patient Age ◽  
Patient Âgé ◽  
History Of ◽  
Pancreatic Cystic Neoplasms

BACKGROUND: The natural history of pancreatic cystic neoplasms remains poorly understood despite growing evidence on the subject. Pancreatic cysts display a wide spectrum of pathological phenotypes, each associated with a different prognostic implication. Many pancreatic cysts are of undetermined malignant potential at presentation and remain so until surgically resected. While the survival rates of patients with malignant cysts are known to be poor, survival rates in patients with undetermined pancreatic cysts are unknown.OBJECTIVE: To identify the factors associated with survival in a group of patients diagnosed with a pancreatic cyst(s).METHODS: The present study was a retrospective multicentre review of pancreatic cystic neoplasms. All patients with a diagnosis of a neoplastic pancreatic cyst from 1994 to 2003 were identified at five different institutions in Edmonton, Alberta. The data collected included patient age, sex, imaging modality, cyst location, cyst size, number of cysts, comorbid illnesses, history of upper abdominal surgery, previous cancer, previous or concurrent metastases, symptoms (pain, upper gastrointestinal bleeding, signs of biliary obstruction, nausea/vomiting), remarkable radiological features, elevated amylase or lipase, type of pancreatic surgery, final pathology (benign or malignant) and overall survival. Survival models were used to assess whether any covariates were predictors of the survival time. Patient data were plotted using the Kaplan-Meier method. The resulting plot was used to calculate survival in the cohort.RESULTS: In total, 64 patients were identified as having neoplastic pancreatic cysts from 1994 to 2003 at the five institutions. The median overall patient survival time was 86 months. The median age at diagnosis for the patient population was 73 years, with 40 patients being women. Univariate analysis revealed that the risk of death was associated with patient age, sex and history of major comorbid illness. Multivariate models identified increased patient age and male sex as the factors that correlated most strongly with decreased overall survival.CONCLUSION: Overall survival in patients with neoplastic pancreatic cysts is determined by patient factors (ie, age and sex) rather than factors descriptive of the cyst such as size and morphology. No conclusions could be made regarding the relationship between cyst pathology and patient survival.

The Outcome of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Cystic Neoplasms: A Systematic Review

2020 ◽  
pp. 1-6
Author(s):  
Viswanath YKS ◽  
Ahmed Mehanna ◽  
Viswanath YKS ◽  
Talvinder Gill ◽  
Anil Reddy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Malignant Tumors ◽  
High Specificity ◽  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms ◽  
Low Sensitivity ◽  
The Uk

Introduction: Pancreatic cancer is the sixth most common cause of death from cancer in the UK. Cystic pancreatic neoplasms are being recognized more with the increase in the use of the CT scan. EUS has been increasingly used to asses and identify lesions in the pancreas, however, it can’t differentiate between benign and malignant tumors alone. The role of EUS guided FNA cytology (EUS FNAC) is still controversial in the management of pancreatic cysts where neoplastic process is questioned. Aim: This systematic review is aiming to explore the currently available evidence assessing the role of EUS guided FNA cytology (EUS FNAC) in the management of pancreatic cystic neoplasms. Methods: A total of five studies with 597 patient EUS FNAC episodes were included in this systematic review. Results: The sensitivity of the EUS FNAC in the papers was variable between 46.7% to 91.7% while the sensitivity of the test was 100% for all the papers except for 1 paper which was 82.1%. CEA level was assessed in 3 papers, however, the cut off level was different. Conclusion: The high specificity of EUS FNAC qualify it as a useful adjunct to ascertain or exclude malignancy in the pancreatic cystic lesions. EUS FNAC cannot be used alone as a method of screening, given low sensitivity. Measuring CEA in the cyst fluid can be a good aide to increase the sensitivity and an identifiable cut off level should be proposed. Well-conducted and powered studies are needed to further explore the role of EUS FNAC in patients with pancreatic cystic neoplastic lesions.

scholarly journals The Yield of String Sign in Differentiating Mucinous from Non-Mucinous Pancreatic Cysts: A Retrospective Cross-Sectional Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 716
Author(s):  
Wisam Sbeit ◽  
Anas Kadah ◽  
Amir Shahin ◽  
Tawfik Khoury
Keyword(s):  
Predictive Value ◽  
Cross Sectional Study ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Mucinous Cystic Neoplasms ◽  
String Sign ◽  
Fluid Analysis ◽  
Group A ◽  
Group B

Background and Objectives: The diagnosis of pancreatic cysts is mostly based on a combination of morphological appearance and fluid analysis of amylase and carcinoembryonic antigen (CEA). We aimed to assess the capability of the string sign in differentiating mucinous from non-mucinous pancreatic cysts. Materials and Methods: All patients who were referred for endoscopic ultrasound (EUS) for pancreatic cysts assessment from 2015 to 2020 were retrospectively analyzed. Results: Our cohort consisted of 112 patients. Of them, 92 patients (82.1%) had mucinous cystic neoplasms (group A) and 20 patients (17.9%) had non-mucinous cystic neoplasms (group B). The average age in groups A and B was 71.3 and 60.4 years, respectively. String sign was positive in 47 patients (51.1%) and negative in 21 patients (22.8%) in group A, while in group B, string sign was negative in 19 patients (95%). String sign showed significant correlation with the diagnosis of mucinous cystic neoplasms (OR 64.2, 95% CI 8.1–508.6, p = 0.0001). Cytology confirmed mucinous cystic neoplasms that included 32 patients; the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of string sign for mucinous cystic neoplasms were high, reaching 93.8%, 85.7%, 96.8%, and 75%, respectively, with an excellent accuracy rate of 92.3%. Conclusions: The string sign is highly accurate for predicting pancreatic mucinous cystic neoplasms, and should be used as an important aid for improving diagnostic accuracy.

scholarly journals THU0467 CONCEPTS AND PERCEPTIONS ABOUT FIBROMYALGIA DIAGNOSIS, MONITORING AND TREATMENT AMONG COLOMBIAN RHEUMATOLOGISTS, PHYSIATRIST AND PAIN PHYSICIAN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 470.1-471
Author(s):  
D. G. Fernández-Ávila ◽  
D. Rincón-Riaño ◽  
J. Gutiérrez
Keyword(s):  
Fibromyalgia Syndrome ◽  
Cross Sectional Study ◽  
Diagnosis And Treatment ◽  
Interdisciplinary Management ◽  
Objective Data ◽  
Cross Sectional ◽  
American College Of Rheumatology ◽  
Orthopedic Surgeons ◽  
Frequent Use ◽  
Knowledge Attitude And Practice

Background:Fibromyalgia is a chronic disease characterized by the presence of widespread and persistent musculoskeletal pain associated with a variety of symptoms. The concepts and perceptions around diagnosis and treatment of fibromyalgia among physicians are not objectively known. The purpose of this study is to obtain objective data through a survey and describe the concepts and perceptions about the diagnosis, treatment and treatment of fibromyalgia among colombian rheumatologists, physiatrist and pain physiciansObjectives:The main purpose of this study is to obtain objective data on this subject and describe the concepts and perceptions about the diagnosis, treatment and monitoring of FM among colombian rheumatologists, physiatrist and pain physicians.Methods:Cross-sectional study. Through a focus group in which two rheumatologists and one expert in qualitative research methods participated, a survey was designed to evaluated the perceptions and concepts that rheumatologists, physiatrist and pain physicians have on the diagnosis and treatment of fibromyalgia. The survey was self-applied anonymously through the internet.Results:Survey applied to 139 rheumatologists, 99 physiatrist and 81 pain physicians. 35 rheumatologists (25.2 %), 17 physiatrist (17.1 %) and 58 pain physicians (71.6 %) consider that there is not enough evidence to recognize fibromyalgia as a disease. 45 rheumatologists (32.4 %), 86 physiatrist (86 %) and 73 pain physicians (90.1 %) consider that the 1990 ACR (American college of Rheumatology) criteria are not sufficient to diagnose fibromyalgia, despite the fact more than 90% of them use the criteria as a tool to approach the diagnosis when suspecting fibromyalgia. The most formulated medications for managing fibromyalgia are antidepressants and is used by more than 80% of the respondents, followed by antiepileptics in pain physician (88.9%) but less than physiatrists and rheumatologists (66.6 % and 64.7 % respectively), and analgesic much more for pain physician and physiatry and less for rheumatologists (84 %, 75.7 % and 26.6 % respectively). All respondents consider that the patient with fibromyalgia should have a multidisciplinary approach. Most doctors of the three specialties believe that physiatrist should be the leaders of interdisciplinary management in the treatment of fibromyalgia patients.Conclusion:We present objective information on the perceptions of fibromyalgia among a group of Colombian rheumatologists, physiatrist and pain physician, documenting a frequent use of the ACR 1990 classification criteria. As regards treatment, a high percentage use of antidepressants and antiepileptic. Most believe that physiatrist should be the leaders of interdisciplinary management in the treatment of fibromyalgia patients.References:[1]Mu R, Li C, Zhu J-X, Zhang X-Y, Duan T-J, Feng M, et al. National survey of knowledge, attitude and practice of fibromyalgia among rheumatologists in China. Int J Rheum Dis. 2013;16:258–63.[2]Arshad A, Kong KO. Awareness and perceptions of fibromyalgia syndrome: a survey of Malaysian and Singaporean rheumatologists. Singapore Med J. 2007;48:25–30.[3]Arshad A, Kong KO, Ooi KK. Awareness and perceptions of fibromyalgia syndrome: a survey of southeast asian rheumatologists. J Clin Rheumatol. 2007;13:59–62.[4]Bloom S, Ablin JN, Lebel D, Rath E, Faran Y, Daphna-Tekoah S, et al. Awareness of diagnostic and clinical features of fibromyalgia among orthopedic surgeons. Rheumatol Int. 2013;33:927–31.[5]Clark P, Paiva ES, Ginovker A, Salomón PA. A patient and physician survey of fibromyalgia across Latin America and Europe. BMC Musculoskelet Disord. 2013;14:188.Disclosure of Interests: :None declared

scholarly journals Diagnosis and management of pancreatic cystic neoplasms

2019 ◽  
Vol 10 (3) ◽  
pp. 300-308 ◽  
Author(s):  
Mathew James Keegan ◽  
Bharat Paranandi
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Guidelines ◽  
Clinicopathological Features ◽  
Evidence Based ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Current Classification ◽  
Pancreatic Cystic Neoplasms

This review outlines the current classification of pancreatic cystic lesions, with a particular emphasis on pancreatic cystic neoplasms (PCNs). It will describe the diagnostic approach to PCNs, with reference to clinicopathological features, cross-sectional radiology and endoscopic ultrasound. This review will conclude with an evidence-based discussion of the management of PCNs focused on recent clinical guidelines.

scholarly journals Evaluating the accuracy of three international guidelines in identifying the risk of malignancy in pancreatic cysts : a retrospective analysis of a surgical treated population

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
A Vanden Bulcke ◽  
J Jaekers ◽  
H Topal ◽  
D Vanbeckevoort ◽  
V Vandecaveye ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Neuroendocrine Tumour ◽  
Pancreatic Cysts ◽  
International Consensus ◽  
Cystic Neoplasms ◽  
Study Results ◽  
Risk Of Malignancy ◽  
Pancreatic Cystic Neoplasms ◽  
Evidence Based Guideline ◽  
The Cost

Background and study aims : The international consensus Fukuoka guideline (Fukuoka ICG), The European evidence-based guideline on pancreatic cystic neoplasms (European EBG) and the American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts (AGA IG) are 3 frequently cited guidelines for the risk stratification of neoplastic pancreatic cysts. The aim of this study was to assess the accuracy of detecting malignant cysts by strictly applying these guidelines retrospectively to a cohort of surgically resected pancreatic cysts. Patient and methods : 72 resected cysts were included in the analysis. Invasive carcinoma, high grade dysplasia and neuroendocrine tumour were considered as “malignant cysts” for the purpose of the study. Results : 32% of the resected cysts were malignant. The analysis showed that the Fukuoka ICG, European EBG and AGA IG had a sensitivity of 66,8%, 95,5%, 80%; a specificity of 26,8%, 11,3%, 43,8%; a positive predictive value of 31,8%, 35%, 47,1% and a negative predicted value of 61,1%, 83,3%, 77,8% respectively. The missed malignancy rate was respectively 11,3%, 1,5%, 7,7% and surgical overtreatment was respectively 48,4%, 59,1%, 34,6%. Conclusion : In this retrospective analysis, the European EBG had the lowest rate of missed malignancy at the expense of a high number of “unnecessary” resections. The Fukuoka ICG had the highest number of missed malignancy. The AGA IG showed the lowest rate of unnecessary surgery at the cost of a high number of missed malignancy. There is need to develop better biomarkers to predict the risk of malignancy.

scholarly journals Large cystic lympangioma of the pancreas: a case reportum

2018 ◽  
Vol 100 (1) ◽  
pp. e12-e14
Author(s):  
SN Jayappa ◽  
P Rao ◽  
AS Tandon ◽  
KGS Bharathy ◽  
SS Sikora
Keyword(s):  
Case Report ◽  
Cystic Mass ◽  
Careful Evaluation ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Pancreatic Cystic Neoplasms ◽  
Sectional Imaging ◽  
Pancreatic Origin

Lymphangioma of the pancreas is rare and presents as a large cystic mass in the retroperitoneum. The pancreatic origin can be confirmed by careful evaluation of cross sectional imaging. Preoperative differentiation from other pancreatic cystic neoplasms is difficult but possible. Large symptomatic lesions warrant surgery. The diagnosis is confirmed by typical features on histopathology and immunohistochemistry. Presented here is a case report of a pancreatic lymphangioma, discussed in the context of available literature.

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