Pancreatic Incidentalomas on CT Colonography: Ignore, Follow up or Investigate?

Area of Science:

• Gastroenterology
• Radiology
• Oncology

Background:

• Cross-sectional abdominal imaging, particularly CT colonography (CTC), is increasingly identifying incidental pancreatic cystic lesions.
• These incidental findings cause patient and clinician anxiety, leading to increased healthcare costs from further investigations.

Purpose of the Study:

• To determine the prevalence of incidental pancreatic cystic lesions found during CTC at a specialized pancreatic center.
• To analyze the management strategies for these incidentally discovered lesions.

Main Methods:

• A retrospective review of CT colonography (CTC) reports and patient records from 2010 to 2016 was conducted.
• Both screening and non-screening patient cohorts were included in the analysis.

Main Results:

• A total of 2.9% of patients (136/4666) had incidental pancreatic lesions, with 2.5% (117/4666) confirmed as cystic.
• Intraductal papillary mucinous neoplasm (IPMN) was reported in 71 patients. Pancreatic ductal adenocarcinoma (PDAC) was incidentally found in 0.2% (12/4666) of patients.
• Follow-up imaging was recommended for 39.3% of patients; one patient with pancreatic duct dilatation developed PDAC after being lost to follow-up.

Conclusions:

• Incidental pancreatic lesions are frequently identified on CT colonography (CTC).
• All patients with pancreatic cystic tumors require referral to a pancreatic multidisciplinary team for tailored management planning.