Kearns Malcolm, Ahmad Nuzhat A
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 7 South, Philadelphia, PA, 1910, USA.
Curr Treat Options Gastroenterol. 2017 Dec;15(4):587-602. doi: 10.1007/s11938-017-0162-y.
Pancreatic cystic neoplasms (PCNs) are being diagnosed with increasing frequency. PCNs have diverse presentations, natural history, and biological behavior. Obtaining an accurate diagnosis of the type of cyst and assessing the potential for malignancy are crucial in determining the appropriate management strategy. Cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI), at experienced centers, is effective in defining the type of cyst as well as identifying high-risk features. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) and cyst fluid analysis can categorize and risk-stratify cysts and is the test of choice in selected patients. However, there is currently no "perfect" test and studies have demonstrated substantial misdiagnosis and over-treatment of benign cysts using standard clinical, imaging, and cyst fluid analyses. Patients with symptomatic cysts or cysts with high-risk features suggestive of malignancy should be considered for surgical resection. Patients with low-risk PCNs can be placed in surveillance protocols with interval imaging. Various gastrointestinal societies have put forth evidence- or consensus-based guidelines that provide a framework for management of PCNs. However, the management can be complex and should ideally be planned in a multidisciplinary fashion by experienced specialists. Recent investigations using molecular markers to risk-stratify cysts offer promise in the future for an effective and accurate management strategy.
胰腺囊性肿瘤（PCNs）的诊断频率日益增加。PCNs具有多样的表现、自然病程和生物学行为。准确诊断囊肿类型并评估恶性潜能对于确定合适的治疗策略至关重要。在经验丰富的中心，采用计算机断层扫描（CT）或磁共振成像（MRI）进行横断面成像，对于明确囊肿类型以及识别高危特征是有效的。内镜超声引导下细针穿刺活检（EUS-FNA）及囊液分析能够对囊肿进行分类并分层评估风险，是部分患者的首选检查。然而，目前尚无“完美”的检查方法，研究表明，使用标准的临床、影像学及囊液分析对良性囊肿存在大量误诊和过度治疗的情况。有症状的囊肿或具有提示恶性的高危特征的囊肿患者应考虑手术切除。低风险PCNs患者可纳入定期影像学检查的监测方案。多个胃肠病学会已提出基于证据或共识的指南，为PCNs的管理提供了框架。然而，治疗可能较为复杂，理想情况下应由经验丰富的专家以多学科方式进行规划。近期利用分子标志物对囊肿进行风险分层的研究为未来有效且准确的治疗策略带来了希望。
