How to detect precursor lesions of pancreatic cancer earlier: the importance of pancreatic cysts

Did you know that the number of pancreatic cystic lesions diagnosed has significantly increased in recent years? It is mainly due to the great improvement in radiological imaging techniques, ageing of the population and increase in awareness of health professionals [1]. Diagnosing these lesions is extremely important as they may have malignant potential and its early recognition could greatly improve outcomes of pancreatic cancer, one of the most lethal diseases.

The presence of any pancreatic #cyst has been found in 3-20% of the patients who underwent an abdominal imaging technique, mainly computerized tomography (CT) or magnetic resonance (MR). These cysts may have different origins: inflammatory, infectious, or neoplastic. Its radiologic diagnosis is challenging due to the location of the pancreas and the variety of lesions that can arise in this organ [2], [3]

Some cysts are actually #pseudocysts. These are not real cysts, as they do not have a true epithelium. These lesions are benign and usually develop after an episode of acute or chronic pancreatitis. It is very important to differentiate pseudocysts from other lesions in the pancreas, since they have no malignant potential and do not require surveillance or treatment when asymptomatic.

Neoplastic cystic lesions account for most pancreatic cystic lesions. There are different types:

- Serous #cystadenoma: It has almost no malignant potential. The classic imaging characteristics are microcystic or honeycomb appearance.

- Mucinous cystic #neoplasms: Almost exclusive of women. The classic Imaging characteristics are macrocystic appearance with septs. Malignant potential around 10-17% and for that reason, close monitoring is required.

- Intraductal papillary mucinous neoplasms (IPMN): Its main feature is the connection with the pancreatic duct, either with the main duct or more commonly with side branches. The main duct usually appears dilated. These are the cysts with the highest risk of malignancy, especially those connected to the main duct, with a rate of malignancy up to 38-60%. For that reason, surgery is a common therapeutic option in these cases, particularly when these show “worrisome features” or large size.

- Solid-pseudopapillary neoplasms: These are rare lesions, more common in young women. Aggressive tumour behaviour occurs in approximately 10% of lesions.

The importance of these lesions lies on its malignant potential. For that reason, an accurate and early diagnosis is of key importance in clinical practice for taking prompt therapeutic decisions and establishing adequate follow-up intervals. To achieve these, a correct radiological diagnosis is extremely important. Artificial intelligence- based tools, as the one developed by Sycai Technologies, will help the radiologists to do a faster and more precise diagnosis with the consequent benefits for the patients in terms of survival and surveillance.




REFERENCES

1. S. Nougaret S, Mannelli L, Pierredonc M.-A. et al. Cystic pancreatic lesions: From increased diagnosis rate to new dilemmas. Diagn Interv Imaging 2016 97 (12): 1275-85

2. Elta C et al. ACG Clinical Guideline: Diagnosis and Management of

Pancreatic Cysts. AJG 2018, 113(4):464-479

3. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018;24:4846–4861.

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