Pancreatic incidentalomas: Investigation and management

The incidence of pancreatic incidentalomas (PIs) detected in otherwise asymptomatic patients is growing with the increasing quality and use of advanced imaging techniques. PI can present as isolated main pancreatic duct dilation or as a solid or cystic lesion. Although historically thought to be rel...

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Bibliographic Details
Published in:Journal of internal medicine 2021-11, Vol.290 (5), p.969-979
Main Authors: Del Chiaro, Marco, Torphy, Robert J., Schulick, Richard D.
Format: Article
Language:English
Subjects:
Computed tomography
Diagnosis
Dilation
Humans
Imaging techniques
Incidental Findings
intraductal papillary mucinous neoplasms
Lesions
Magnetic Resonance Imaging
Malignancy
Medical imaging
Morbidity
mucinous cystic neoplasms (MCNs)
Neoplasms
Pancreas
Pancreatic cancer
pancreatic cystic neoplasms
pancreatic incidentalomas
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - therapy
Tomography, X-Ray Computed
Tumors
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Summary:The incidence of pancreatic incidentalomas (PIs) detected in otherwise asymptomatic patients is growing with the increasing quality and use of advanced imaging techniques. PI can present as isolated main pancreatic duct dilation or as a solid or cystic lesion. Although historically thought to be relatively rare, PIs are rather common, particularly cystic lesions of the pancreas, which can be detected in up to 49% of the general population. With the poor prognosis of pancreatic cancer, PIs are an opportunity for prevention and early diagnosis, but when managed poorly, they can also lead to overtreatment and unnecessary morbidity. The management of PI should begin with a dedicated pancreas protocol computed tomography (CT) scan or magnetic resonance imaging (MRI) to accurately characterize duct size, lesion characteristics and establish an accurate baseline for subsequent follow up. Diagnosis and subsequent management depends on the extent of main duct dilation and solid versus cystic appearance. Solid lesions are highly concerning for malignancy. Cystic lesions can be further categorized as intraductal papillary mucinous neoplasms of the pancreas (IPMNs) or mucinous cystic neoplasms (MCNs), both of which harbour malignant potential, or as serous cystic neoplasms (SCNs) that are benign. In this paper, we summarize the major challenges related to PI and present pragmatic suggestions for management.   
ISSN:0954-6820
1365-2796
DOI:10.1111/joim.13359