Pancreatic Cystic Lesions on MRI: What Is The Likelihood of a Present or Future Diagnosis of Pancreatic Carcinoma?

Abstract

BackgroundPancreatic cystic lesions (PCLs) are followed for years due to older and likely biased works demonstrating a strong association with pancreatic carcinoma; more recent data are needed clarifying this relationship.PurposeTo determine the association between PCLs on MRI and a synchronous or future diagnosis of pancreatic carcinoma.Study typeSingle‐center retrospective cohort.PopulationA total of 192 patients (111 female, 58%) with median age 66 years (range 26–87 years) with PCLs on abdominal MRI from 2011 to 2016.Field Strength/Sequences1.5 T and 3 T, including T2WI, T1WI, diffusion weighted imaging and contrast‐enhanced T1WI.AssessmentEach PCL was reviewed independently by 2 of 10 fellowship‐trained abdominal radiologists. Fukuoka guideline worrisome features and high‐risk stigmata were evaluated. Follow‐up imaging and clinical notes were reviewed within a system that captures pancreatic carcinoma for the region, for a median follow‐up of 67 months (interquartile range: 43–88 months).Statistical TestsPancreatic carcinoma prevalence and incidence rate for future carcinoma with 95% confidence intervals (95% CI). Fisher exact test, logistic regression with odds ratios (OR) and the Wilcoxon rank‐sum test were used to assess PCL morphologic features with the Kolmogorov–Smirnov test used to assess for normality. P < 0.05 defined statistical significance.ResultsThe prevalence of pancreatic carcinoma on initial MRI showing a PCL was 2.4% (95% CI: 0.9%, 5.2%). Thickened/enhancing cyst wall was associated with pancreatic carcinoma, OR 52 (95% CI: 4.5, 1203). Of 189 patients with a PCL but without pancreatic carcinoma at the time of initial MRI, one developed high‐grade dysplasia and none developed invasive carcinoma for an incidence rate of 0.97 (95% CI: 0.02, 5.43) and 0 (95% CI: 0, 3.59) cases per 1000 person‐years, respectively.Data ConclusionA low percentage of patients with a PCL on MRI had a pancreatic carcinoma at the time of initial evaluation and none developed carcinoma over a median 67 months of follow‐up.Evidence Level3Technical Efficacy5

Percentage of Pancreatic Cysts on MRI With a Pancreatic Carcinoma: Systematic Review and Meta‐Analysis

“…Fifteen studies met the inclusion criteria, all of which were retrospective. 18,19,27,[33][34][35][36][37][38][39][40][41][42][43][44] PCLs on MRI with Pancreatic Carcinoma at the Time of Initial MRI Eight studies reported on PCLs with a PDAC at the time of initial MRI (Table 1). 27,[33][34][35][37][38][39]44 The median year of publication for the eight publications was 2017 (range, 2010-2022).…”

“…18,19,27,[33][34][35][36][37][38][39][40][41][42][43][44] PCLs on MRI with Pancreatic Carcinoma at the Time of Initial MRI Eight studies reported on PCLs with a PDAC at the time of initial MRI (Table 1). 27,[33][34][35][37][38][39]44 The median year of publication for the eight publications was 2017 (range, 2010-2022). All studies used single-center databases from Italy (N = 4), Bulgaria (N = 1), Canada (N = 1), Japan FIGURE 4: Forest plot illustrating the percentage of patients with pancreatic cystic lesions on MRI who were diagnosed with pancreatic adenocarcinoma on a future date while on surveillance, with 95% confidence intervals (95% CI).…”

“…Two studies provided sufficiently granular data for patients without worrisome features or high-risk stigmata, which were pooled and showed the percentage of individuals with PCLs and PDAC at the time of initial MRI to be 0.97% (95% CI 0.08-2.54). 27,37 RISK OF BIAS AND APPLICABILITY. Five studies were at low risk of bias, 27,33,34,37,44 while three studies were identified as at risk (Figure 3).…”

“…27,37 RISK OF BIAS AND APPLICABILITY. Five studies were at low risk of bias, 27,33,34,37,44 while three studies were identified as at risk (Figure 3). 35,38,39 Three studies were limited to only patients who had histopathology, each of which was considered at risk for selection bias due to the retrospective exclusion of PCLs that did not meet criteria for resection or fluid/ tissue sampling.…”

“…Ten studies reported on PCLs with a future diagnosis of PDAC (Table 2). 18,19,27,34,36,[40][41][42][43][44] The range of surveillance for the 10 studies was 3.2 to 157 months. Of 10 studies, 8 had a median surveillance ≥3 years.…”