Keane Margaret G, Afghani Elham
Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
J Clin Med. 2021 Mar 19;10(6):1284. doi: 10.3390/jcm10061284.
Pancreatic cystic lesions are an increasingly common clinical finding. They represent a heterogeneous group of lesions that include two of the three known precursors of pancreatic cancer, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Given that approximately 8% of pancreatic cancers arise from these lesions, careful surveillance and timely surgery offers an opportunity for early curative resection in a disease with a dismal prognosis. This review summarizes the current evidence and guidelines for the diagnosis and management of IPMN/MCN. Current pre-operative diagnostic tests in pancreatic cysts are imperfect and a proportion of patients continue to undergo unnecessary surgical resection annually. Balancing cancer prevention while preventing surgical overtreatment, continues to be challenging when managing pancreatic cysts. Cyst fluid molecular markers, such as , , , , and , as well as emerging endoscopic technologies such as needle-based confocal laser endomicroscopy and through the needle microbiopsy forceps demonstrate improved diagnostic accuracy. Differences in management and areas of uncertainty between the guidelines are also discussed, including indications for surgery, surveillance protocols and if and when surveillance can be discontinued.
胰腺囊性病变是一种越来越常见的临床发现。它们代表了一组异质性病变，其中包括胰腺癌三种已知前体中的两种，即导管内乳头状黏液性肿瘤（IPMN）和黏液性囊性肿瘤（MCN）。鉴于约8%的胰腺癌起源于这些病变，仔细监测并及时手术为这种预后不佳的疾病提供了早期根治性切除的机会。本综述总结了IPMN/MCN诊断和管理的当前证据及指南。目前胰腺囊肿的术前诊断测试并不完美，每年仍有一部分患者接受不必要的手术切除。在管理胰腺囊肿时，平衡癌症预防与避免手术过度治疗仍然具有挑战性。囊液分子标志物，如……以及新兴的内镜技术，如基于针的共聚焦激光内镜显微镜和经针微生物活检钳，显示出更高的诊断准确性。还讨论了指南之间在管理和不确定性方面的差异，包括手术指征、监测方案以及是否以及何时可以停止监测。
