Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States.
World J Gastroenterol. 2021 Sep 14;27(34):5700-5714. doi: 10.3748/wjg.v27.i34.5700.
Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. Surgery should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass, nodule and dilated main pancreatic duct. EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery. For presumed low risk cysts, surveillance strategies will be discussed. Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines.
偶然发现的胰腺囊肿很常见，其中一些囊肿有恶性潜能。最常见的胰腺囊性肿瘤包括浆液性囊腺瘤、黏液性囊腺瘤和导管内乳头状黏液性肿瘤。对胰腺囊肿进行风险分层对于决定患者是否可能受益于内镜超声（EUS）或手术切除非常重要。对于恶性囊肿或根据各种风险特征（包括实性肿块、结节和主胰管扩张）提示有发展为恶性的高风险囊肿，应保留手术治疗。EUS 可补充对那些在影像学上仍不确定或具有可疑特征的囊肿的磁共振成像发现。各种囊液标志物，包括癌胚抗原、葡萄糖、淀粉酶、细胞学和 DNA 标志物，有助于区分黏液性和非黏液性囊肿。这篇综述将指导临床医生如何评估偶然发现的胰腺囊肿，以及何时考虑转介进行 EUS 或手术。对于疑似低风险囊肿，将讨论监测策略。胰腺囊肿的管理需要个体化的方法，这是由各种指南指导的。
