[Pancreatic cystic neoplasms: work-up and surveillance]

Whereas pancreatic masses are often difficult to detect with transabdominal ultrasound, cross-sectional imaging features high sensitivity for the pancreatic tumors. However, increasing availability of magnetic resonance imaging (MRI) has led to a surge in the detection of benign or precancerous pancreatic lesions. The medical history is characteristic only for two entities. A history of acute or chronic pancreatitis favors a benign pseudocyst while weight loss or jaundice are suggestive of malignancy. More challenging is the classification of asymptomatic cysts, which often require extensive work-up and, in advanced stages, pancreatic resection. In case of overdiagnosis and overtreatment, this is also referred to as VOMIT: victims of modern imaging technology (1). On the other hand, it is important to identify precancerous lesions that should be monitored with the aim of timely recognizing progression towards invasive cancer. The aim of this overview is to focus on incidentally detected pancreatic cystic lesions with a description of the investigations and surveillance. Pancreatic cancer and pseudocysts are beyond the scope of this review. However, the latter are discussed in terms of differential diagnoses, as pseudocysts are occasionally found by chance in everyday clinical practice, but should not be monitored.