CT Abdomen The presence of high-risk stigmata or worrisome features significantly increases the risk of malignancy, and therefore EUS-FNA is favored over CT in this setting [8,9,14]. In cases in which EUS-FNA cannot be performed and the patient is not a candidate for MRI with MRCP, a dual-phase contrast-enhanced pancreatic protocol CT may still be of value for cyst characterization or presurgical planning [1,7-10,13,19-21]. The use of IV contrast improves detection of worrisome features and high-risk stigmata and the assessment of surrounding anatomy [1,7-10,13,19- 21]. Pancreatic Cyst US Abdomen Endoscopic When high-risk stigmata or worrisome features are present, the appropriate initial imaging study is EUS-FNA [7- 10]. The unique advantage of EUS-FNA is its ability to distinguish mucinous from nonmucinous lesions by means of biochemical markers assayed from cyst fluid samples. This facilitates a specific diagnosis in many cases [25,28- 30]. For instance, the presence of nongut mucin supports a diagnosis of mucinous neoplasm. Carcinoembryonic antigen levels <5 ng/mL suggest pseudocyst or serous cystadenoma. A carcinoembryonic antigen threshold level in the range of 192 to 200 ng/mL is 80% accurate for diagnosis of a mucinous cyst [13,29]. Amylase levels of >250 IU/L suggest a pseudocyst. Molecular assays for markers such as K-ras, GNAS, PTEN, VHL, TP53, and PIK3CA may also assist in differentiating neoplastic cystic lesions and predicting cyst behavior. When performed in centers with expertise in EUS-FNA, cytological evaluation can identify atypia, dysplasia, or neoplasia [7,13,25]. Studies have demonstrated that the presence of high-grade epithelial atypia in IPMN detects approximately 30% more cancers than the presence of worrisome imaging features alone [13]. Pancreatic Cyst Variant 5: Follow-up imaging of pancreatic cyst. CT Abdomen The risk of malignant transformation of a pancreatic cyst is approximately 0.24% per year [9].
Pancreatic Cyst. CT Abdomen The presence of high-risk stigmata or worrisome features significantly increases the risk of malignancy, and therefore EUS-FNA is favored over CT in this setting [8,9,14]. In cases in which EUS-FNA cannot be performed and the patient is not a candidate for MRI with MRCP, a dual-phase contrast-enhanced pancreatic protocol CT may still be of value for cyst characterization or presurgical planning [1,7-10,13,19-21]. The use of IV contrast improves detection of worrisome features and high-risk stigmata and the assessment of surrounding anatomy [1,7-10,13,19- 21]. Pancreatic Cyst US Abdomen Endoscopic When high-risk stigmata or worrisome features are present, the appropriate initial imaging study is EUS-FNA [7- 10]. The unique advantage of EUS-FNA is its ability to distinguish mucinous from nonmucinous lesions by means of biochemical markers assayed from cyst fluid samples. This facilitates a specific diagnosis in many cases [25,28- 30]. For instance, the presence of nongut mucin supports a diagnosis of mucinous neoplasm. Carcinoembryonic antigen levels <5 ng/mL suggest pseudocyst or serous cystadenoma. A carcinoembryonic antigen threshold level in the range of 192 to 200 ng/mL is 80% accurate for diagnosis of a mucinous cyst [13,29]. Amylase levels of >250 IU/L suggest a pseudocyst. Molecular assays for markers such as K-ras, GNAS, PTEN, VHL, TP53, and PIK3CA may also assist in differentiating neoplastic cystic lesions and predicting cyst behavior. When performed in centers with expertise in EUS-FNA, cytological evaluation can identify atypia, dysplasia, or neoplasia [7,13,25]. Studies have demonstrated that the presence of high-grade epithelial atypia in IPMN detects approximately 30% more cancers than the presence of worrisome imaging features alone [13]. Pancreatic Cyst Variant 5: Follow-up imaging of pancreatic cyst. CT Abdomen The risk of malignant transformation of a pancreatic cyst is approximately 0.24% per year [9].