TY - JOUR
T1 - Recent advances in the diagnostic evaluation of pancreatic cystic lesions
AU - Ardeshna, Devarshi R.
AU - Cao, Troy
AU - Rodgers, Brandon
AU - Onongaya, Chidiebere
AU - Jones, Dan
AU - Chen, Wei
AU - Koay, Eugene J.
AU - Krishna, Somashekar G.
N1 - Publisher Copyright:
© The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2022/2/14
Y1 - 2022/2/14
N2 - Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.
AB - Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.
KW - Confocal laser endomicroscopy
KW - Intraductal papillary mucinous neoplasms
KW - Microforceps biopsy
KW - Mucinous cystic neoplasm
KW - Pancreatic cystic lesion
KW - Radiomics
KW - Pancreatic Cyst/diagnostic imaging
KW - Pancreatic Neoplasms/diagnostic imaging
KW - Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
KW - Cyst Fluid
KW - Humans
KW - Pancreas/pathology
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U2 - 10.3748/wjg.v28.i6.624
DO - 10.3748/wjg.v28.i6.624
M3 - Review article
C2 - 35317424
AN - SCOPUS:85125116131
SN - 1007-9327
VL - 28
SP - 624
EP - 634
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
IS - 6
ER -