Clores Michael J, Thosani Amar, Buscaglia Jonathan M
Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA.
J Multidiscip Healthc. 2014 Feb 3;7:81-91. doi: 10.2147/JMDH.S43098. eCollection 2014.
Pancreatic cystic lesions are commonly encountered today with the routine use of cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). The majority of patients discovered to have a pancreatic cyst are completely asymptomatic; yet the presence of such a finding instills fear in the minds of both patient and physician, as the concern for malignant transformation to pancreatic cancer is great despite the relatively low overall likelihood of cyst progression. Not all cysts in the pancreas represent pancreatic cystic neoplasms (PCNs), and not all PCNs have significant malignant potential. Mucinous PCNs are the most concerning, as these lesions have the greatest potential for cancerous transformation to adenocarcinoma. Within the group of mucinous PCNs, intraductal papillary mucinous neoplasms (IPMNs) involving the main pancreatic duct are the most worrisome, and surgical resection should be pursued if the patient has appropriate operative risks. IPMN lesions involving the branch ducts, and mucinous cystadenomas, have a lower likelihood for malignancy, and they may be closely followed for the development of any worrisome or high-risk features. Surveillance of known PCNs is performed with a combination of CT, MRI and endoscopic ultrasound (EUS). EUS-guided fine-needle aspiration (EUS-FNA) may be used to assess cyst fluid cytology, and also to detect cyst fluid amylase level, carcinoembryonic antigen level, and DNA molecular analysis in certain cases. The presence or absence of specific cyst morphological features, as well as the cyst fluid analysis, is what enables the physician to guide the patient towards continued surveillance, versus the pursuit of surgical resection.
如今，随着计算机断层扫描（CT）和磁共振成像（MRI）等横断面成像方式的常规使用，胰腺囊性病变很常见。大多数被发现患有胰腺囊肿的患者完全没有症状；然而，这样的检查结果会使患者和医生都感到恐惧，因为尽管囊肿进展为胰腺癌的总体可能性相对较低，但对恶性转化为胰腺癌的担忧很大。并非胰腺中的所有囊肿都代表胰腺囊性肿瘤（PCN），也并非所有PCN都具有显著的恶性潜能。黏液性PCN最令人担忧，因为这些病变发生腺癌癌变的可能性最大。在黏液性PCN组中，累及主胰管的导管内乳头状黏液性肿瘤（IPMN）最令人担忧，如果患者有合适的手术风险，应进行手术切除。累及分支导管的IPMN病变和黏液性囊腺瘤的恶性可能性较低，可以密切观察是否出现任何令人担忧或高风险的特征。对已知的PCN进行监测时，结合使用CT、MRI和内镜超声（EUS）。EUS引导下细针穿刺抽吸（EUS-FNA）可用于评估囊液细胞学，在某些情况下还可检测囊液淀粉酶水平、癌胚抗原水平和DNA分子分析。特定囊肿形态特征的有无以及囊液分析，使医生能够指导患者是继续监测还是进行手术切除。
