Identifying Neoplastic Versus Non-neoplastic Pancreatic Cystic Lesions-What Is the Current Evidence?

Area of Science:

• Gastroenterology
• Radiology
• Oncology

Background:

• Increasing detection of pancreatic cystic lesions (PCLs) due to advanced imaging.
• PCLs exhibit variable malignant potential, necessitating careful evaluation.
• Management strategies range from surveillance to biopsy or surgical excision.

Purpose of the Study:

• To review the diagnostic accuracy of imaging modalities for PCLs.
• To evaluate the role of endoscopic and molecular tools in PCL assessment.
• To summarize current approaches for PCL diagnosis and management.

Main Methods:

• Narrative literature review.
• Focus on diagnostic accuracy of imaging (CT, MRI).
• Evaluation of endoscopic ultrasonography (EUS) and cyst fluid analysis.

Main Results:

• Cross-sectional imaging achieves ~50% accuracy in cyst classification; MRI generally outperforms CT.
• EUS is valuable for inconclusive cases or high-risk features, potentially guiding surgical intervention.
• EUS-guided fine-needle aspiration with fluid analysis aids in differentiating mucinous from non-mucinous cysts.

Conclusions:

• A multimodal diagnostic strategy combining imaging, EUS, and cyst fluid analysis is essential for PCLs.
• Biomarker advancements offer future potential for improved risk stratification and personalized PCL management.