What is Causing the Increased Detection of Pancreatic Cysts?

Advances in imaging technologies over the past decades have greatly increased the numbers of pancreatic cysts detected, researchers report in the April issue of Clinical Gastroenterology and Hepatology. With further improvements in pancreatic imaging, more pancreatic cysts are likely to be discovered, so gastroenterologists, surgeons, endoscopic ultrasound specialists, and primary care physicians should all become familiar with practice guidelines to meet the growing demand in clinical consultation for pancreatic cystic lesions.

The only known precursors of pancreatic cancers, apart from rare inherited genetic disorders, are pancreatic cystic neoplasms.

Increased trend of incident pancreatic cysts.

Increased trend of incident pancreatic cysts in the past decade.

There has been a trend of increased diagnosis of incidental cysts in recent years. This increase has been proposed to result from the development and widespread use of new imaging techniques that improve detection of these lesions.

Maria Moris et al investigated the prevalence of incidental pancreatic cystic lesions in patients undergoing magnetic resonance imaging (MRI) for nonpancreatic indications, according to their technical features.

They reviewed the records of the first 50 abdominal MRI studies performed each year, from 2005 to 2014, with detailed data pertaining to the hardware and software used in the examinations. All of the images from each study (500 total) were downloaded and re-examined by an expert pancreatic MRI radiologist.

Of the 500 patients analyzed, 208 patients (41.6%) were found to have an incidental cyst. Interestingly, only 44 patients had a pancreatic cyst reported on their original study interpretation. Most of the cysts were small (median size, 4 mm), and roughly half of the patients (52%) had more than 1 cyst.

An increased trend of pancreatic cysts was seen over the 10 years (see figure), with no statistically significant differences in the demographic variables among groups.

Newer versions of imaging hardware and software were associated with a significant increase in cyst detection. The prevalence was as high as 56% in a newer version of the hardware (Skyra), compared with only 23% prevalence in an older version of the imaging hardware (Sonata).

Older age, diabetes, and the presence of non-pancreatic cancer (specifically non-melanoma skin cancer and hepatocarcinoma) were also associated with the presence of cysts.

Moris et al conclude that the increase in pancreatic cyst prevalence results from newer versions of MRI hardware and software, rather than an increase in number of cysts in patients.

In an editorial that accompanies the article, Mohamed O. Othman and Jonathan M. Buscaglia explain that it is important to carefully manage patients’ pancreatic cysts, which are associated with a 3-fold increase in risk of pancreatic cancer and a 1.4-fold increase in all-cause mortality in patients younger than 65 years old.

However, they add that it is important to remember that the data derived from this study are applicable for incidental pancreatic cysts only. Patients with a known history of pancreatic diseases, or those who had an MRI performed for pancreatic indications, were excluded from the study.

Othman and Buscaglia say that with further improvements in pancreatic imaging, more cysts will be discovered and referred to gastroenterologists. With a barrage of new pancreatic cysts likely to be encountered over the next decades, the burden of this clinical load should become more evenly dispersed among all physicians involved—not just general gastroenterologists and EUS specialists, but also primary care physicians.

In April 2015, the American Gastroenterological Association published practice guidelines on the diagnosis and management of asymptomatic neoplastic pancreatic cysts.

Othman and Buscaglia explain that standardization in disease management will improve patient outcomes and hopefully help contain the increases in costs that could ensue as clinicians are faced with this growing group of patients.

This article has an accompanying CME activity.

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