Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee

Megibow, Alec J.; Baker, Mark E.; Morgan, Desiree E.; Kamel, Ihab R.; Sahani, Dushyant V.; Newman, Elliot; Brugge, William R.; Berland, Lincoln L.; Pandharipande, Pari V.

doi:10.1016/j.jacr.2017.03.010

Cited by 229 publications

(214 citation statements)

References 78 publications

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“…Other risk factors include IPMN growth of more than 2 mm per year and an elevated level of Ca 19-9 (6) . When one or more of these high-risk features are identified on CT or MRI scans, surgical intervention, preceded or not by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), can be considered (5,14,15) . Some authors recommend that any cyst that is a candidate for resection should undergo to EUS-FNA, in order to reduce the number of unnecessary surgeries (15) .…”

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confidence: 99%

“…In a recent article published by the ACR Incidental Findings Committee, as the first revision of the document released in 2010, Megibow et al (15) stated that the recommendations are based not only on the level of evidence but also on personal experience, when evidence is lacking, and their consensus is a guidance rather than formal guidelines. The main changes proposed in the management of patients with incidental pancreatic cysts were a longer follow-up period (10 years)-due to reports of the development of invasive pancreatic adenocarcinoma after 5 years of follow-up (16,17) -a more liberal use of EUS-FNA, and the recommendation to discontinue follow-up beyond 80 years of age, except when there are symptoms.…”

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confidence: 99%

“…Megibow et al (15) suggested that growth of a cyst (sufficient to raise suspicion of malignancy) can be defined as an increase in its diameter > 100% if it has an initial diameter < 0.5 cm, > 50% if it has an initial diameter of ≥ 0.5 to < 1.5 cm, and > 20% if it has an initial diameter ≥ 1.5 cm. Of course, from a mathematical point of view, a 40% increase in a 1.4-cm cyst is more significant than is a 25% increase in a 1.5-cm cyst, which makes the use of common sense essential when following this particular criteria.…”

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confidence: 99%

“…However, Megibow et al. (15) proposed a specific algorithm for small cysts (1.5-2.5 cm) suspected of being IPMNs, recommending longer intervals between imaging studies for patients with cysts < 2.0 cm.…”

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confidence: 99%

“…That variation might be due to the histological criteria adopted to consider the malignancy of the lesion. Ultimately, it can be said that exact rates of malignancy of small incidental pancreatic cysts remain unknown (15,21) .…”

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confidence: 99%

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Incidental pancreatic cyst: still a lot of road to cover

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confidence: 99%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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D'Ippólito

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Pancreatic Cysts—An Overview and Summary of Society Guidelines, 2021

Ayoub

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2021

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Significant Incidental Findings in the National Lung Screening Trial

et al. 2023

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ImportanceLow-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described.ObjectiveTo describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology’s white papers on incidental findings.Design, Setting, and ParticipantsThis was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers.Main Outcomes and MeasuresSignificant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm.ResultsOf 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24 123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75 126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer.Conclusions and RelevanceThis case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

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Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee

Cited by 229 publications

References 78 publications

Incidental pancreatic cyst: still a lot of road to cover

Incidental pancreatic cyst: still a lot of road to cover

Pancreatic Cysts—An Overview and Summary of Society Guidelines, 2021

Significant Incidental Findings in the National Lung Screening Trial

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