Lee Linda S
Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2014 Sep;30(5):511-7. doi: 10.1097/MOG.0000000000000098.
Diagnosis of pancreatic cysts remains challenging due to limitations of currently available radiologic and endoscopic tools. The diagnostic approach should focus on identifying mucinous and malignant cysts. Mucinous cysts require further differentiation to allow appropriate management.
Although the overall rate of malignant pancreatic cysts is low, it remains higher than the general population. MRI with magnetic resonance cholangiopancreatography is the preferred imaging modality for pancreatic cysts. Attempts to improve diagnostic yield of endoscopic ultrasound-guided fine needle aspiration include performing cyst wall cytology and DNA analysis. The 2012 international consensus guidelines for mucinous cystic neoplasm and intraductal papillary mucinous neoplasm are superior to the original 2006 guidelines, although issues include the relatively poor ability to diagnose malignant cysts leading to unnecessary surgeries and the de-emphasis of cyst size. Cyst size remains an important predictor of malignancy. Translational research involving genomics, microRNA, proteomics, and metabolomics holds promise for improved biomarkers. Endoscopic innovations may safely aid in cyst diagnosis.
Incremental improvements in pancreatic cyst diagnosis have occurred with new biomarkers and endoscopic tools requiring validation in large-scale studies.
由于目前可用的放射学和内镜工具存在局限性，胰腺囊肿的诊断仍然具有挑战性。诊断方法应侧重于识别黏液性和恶性囊肿。黏液性囊肿需要进一步鉴别以进行适当的管理。
尽管胰腺恶性囊肿的总体发生率较低，但仍高于一般人群。磁共振胰胆管造影的磁共振成像（MRI）是胰腺囊肿的首选成像方式。提高内镜超声引导下细针穿刺诊断率的尝试包括进行囊肿壁细胞学检查和DNA分析。2012年黏液性囊性肿瘤和导管内乳头状黏液性肿瘤的国际共识指南优于2006年的原始指南，尽管存在一些问题，包括诊断恶性囊肿的能力相对较差导致不必要的手术，以及对囊肿大小的重视不足。囊肿大小仍然是恶性肿瘤的重要预测指标。涉及基因组学、微小RNA、蛋白质组学和代谢组学的转化研究有望提供更好的生物标志物。内镜创新可能会安全地辅助囊肿诊断。
新的生物标志物和内镜工具在胰腺囊肿诊断方面取得了渐进性进展，但需要在大规模研究中进行验证。
