Diagnosis and Surveillance of Incidental Pancreatic Cystic Lesions: 2017 Consensus Recommendations of the Korean Society of Abdominal Radiology

Abstract

The occurrence of incidentally detected pancreatic cystic lesions (PCLs) is continuously increasing. Radiologic examinations including computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreatography have been widely used as the main diagnostic and surveillance methods for patients with incidental PCLs. Although most incidentally detected PCLs are considered benign, they have the potential to become malignant. Currently, we have several guidelines for the management of incidental PCLs. However, there is still debate over proper management, in terms of accurate diagnosis, optimal follow-up interval, and imaging tools. Because imaging studies play a crucial role in the management of incidental PCLs, the 2017 consensus recommendations of the Korean Society of Abdominal Radiology for the diagnosis and surveillance of incidental PCLs approved 11 out of 16 recommendations. Although several challenges remain in terms of optimization and standardization, these consensus recommendations might serve as useful tools to provide a more standardized approach and to optimize care of patients with incidental PCLs.

Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology

“…The six-point modified Delphi method was used to collect the opinions of the participants. The participants replied to each statement using one of six choices: "strongly agree," "agree with minor reservations," "agree with major reservations," "disagree with minor reservations," "disagree with major reservations," and "strongly disagree" (7). If more than 80% of the participants with more than 2 years of experience in biliary imaging chose "strongly agree" or "agree with minor reservations" for a given statement, it was considered to have reached consensus.…”

“…Although some guidelines cover diagnostic imaging, the presented recommendations are general guidelines for diagnosis, treatment, and prognosis, and they are not concerned with specific technical aspects or diagnostic criteria for evaluating EHD cancer (4). Recently, the Korean Society of Abdominal Radiology (KSAR) developed consensus recommendations on controversial issues in abdominal radiology (5)(6)(7). South Korea has a high incidence of EHD cancer, and consequently, many of the KSAR members have gained extensive experience in the evaluation of EHD cancer.…”

Advances in the Diagnosis of Pancreatic Cystic Lesions

“…However, since the pathologist frequently does not have diagnostic material available, a multidisciplinary and multimodal team approach is needed, based on an integrative judgement including imaging findings, cyto- and histopathology data, cyst fluid biochemical and molecular testing. The current management options include no surveillance for clearly proven benign cysts or in non-surgical candidates; surveillance for those with potential for malignant transformation; or surgical resection of a cyst with high risk features for malignancy [ 11 , 12 , 13 , 14 ]. The focuses are to identify all malignant lesions that are amenable to curative surgical treatment and lower the number of surgeries performed for those with benign lesions.…”

“…Several guidelines have been published in recent years in an attempt to better guide clinicians to manage these conditions [ 11 , 12 , 13 , 14 ]. They all agree that some morphologic features identified in cross-sectional imaging, such as enhancing mural nodules with a size of 5 mm or more, dilation of the main pancreatic duct of more than 10 mm or occurrence of jaundice in the presence of a pancreatic head cystic lesion, represent high risk stigmata and clear indications to operate on a surgically fit patient.…”

Diagnostic Approach to Incidentally Detected Pancreatic Cystic Lesions

“…Multiple guidelines have been published on the diagnostic approach to PLCs [9][10][11][12][13], but no one has clearly answered this important issue. The answer to this question starts from asking if subsequent imaging modalities would change the decision-making process.…”