Evaluation and management of pancreatic cystic lesions

Pancreatic cystic lesions are now being encountered more frequently in clinical practice because of widely available high quality imaging. These lesions have varying malignant potential and include benign pseudocysts and serous cystadenomas (32%-29%), premalignant mucinous cystadenomas (10%-45%) and intraductal papillary mucinous neoplasms (21%-33%), and malignant mucinous cystadenocarcinomas (<1%). The benign lesions can be followed conservatively while pre-malignant and malignant lesions require surgical resection. Although surgery is the only definitive way to diagnose these lesions, endoscopic ultrasound with fine-needle aspiration for cytology and cyst fluid analysis is currently the best non-surgical approach available to aid in the diagnosis of these lesions. There is currently no consensus guideline for the management of pancreatic cystic lesions. In this article we attempt to summarize the literature on pancreatic cysts and review the latest methodology for evaluation and management.