Recent advances in the diagnostic evaluation of pancreatic cystic lesions

Abstract

Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.

Keywords: Pancreatic cystic lesion, Intraductal papillary mucinous neoplasms, Mucinous cystic neoplasm, Microforceps biopsy, Radiomics, Confocal laser endomicroscopy

Core Tip: Pancreatic cystic lesions (PCLs) are highly prevalent. It is critical to accurately diagnose PCLs and risk stratify them to guide management. Current diagnostic techniques are suboptimal; hence, recent investigations have focused on developing, refining, and validating novel technologies for accurately diagnosing specific cyst type and ascertaining high-risk lesions for malignancy. Radiomics, cyst-fluid biomarkers, confocal laser endomicroscopy and microforceps biopsy hold the promise of accurately diagnosing PCLs and improving their management.