Natural history of asymptomatic pancreatic cystic neoplasms

HPB (Oxford). 2013 Mar;15(3):175-81. doi: 10.1111/j.1477-2574.2012.00522.x. Epub 2012 Jul 23.

Abstract

Background: The management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history.

Objectives: This study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis.

Methods: Asymptomatic cysts were identified from a prospectively maintained database. Sequential cross-sectional imaging studies were assessed, and results of endoscopic ultrasound-guided aspiration were co-analysed.

Results: A total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow-up was 5.1 years [interquartile range (IQR): 4.1-6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6-1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7-1.6 cm) during follow-up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0-3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0-4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post-presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions.

Conclusions: Asymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis.

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Disease Progression
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms, Cystic, Mucinous, and Serous / pathology*
  • Neoplasms, Cystic, Mucinous, and Serous / therapy
  • Pancreatectomy
  • Pancreatic Cyst / pathology*
  • Pancreatic Cyst / therapy
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / therapy
  • Pancreaticoduodenectomy
  • Patient Selection
  • Predictive Value of Tests
  • Prognosis
  • Time Factors
  • Watchful Waiting