Hepato-pancreato-biliary
Michael J. Kirsch, II, MD, MS
Resident Physician
University of Colorado Anschutz Medical Campus
Denver, Colorado, United States
Michael J. Kirsch, II, MD, MS
Resident Physician
University of Colorado Anschutz Medical Campus
Denver, Colorado, United States
Michael J. Kirsch, II, MD, MS
Resident Physician
University of Colorado Anschutz Medical Campus
Denver, Colorado, United States
Jacob Edwards, BS
Medical Student
University of Colorado School of Medicine, United States
Salvador Rodriguez Franco, MD (he/him/his)
Senior Research Associate
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
Oskar Franklin, MD, PhD
Visiting Research Fellow
University of Colorado Anschutz Medical Campus, Department of Sugery, Division of Surgical Oncology
Englewood, Colorado, United States
Toshitaka Sugawara, MD, PhD
Research Fellow
University of Colorado Anschutz Medical Center, Department of Surgery, Division of Surgical Oncology
Denver, Colorado, United States
Thomas Stoop, MD
Research Fellow
University of Colorado Anschutz Medical Center, Department of Surgery, Division of Surgical Oncology, United States
Ellie Svoboda, MLIS, AHIP
Clinical Instructor
University of Colorado Anschutz Medical Campus, Strauss Health Science Library, United States
Richard D. Schulick, MD, MBA
Chair of Surgery and Cancer Center Director
University of Colorado, Department of Surgery, United States
Marco Del Chiaro, MD, PhD
Division Chief Surgical Oncology
University of Colorado Anschutz Medical Campus, United States
Cystic lesions of the pancreas have been observed in up to 49.1% of the general population. With improved imaging techniques, they are being detected at smaller sizes and earlier stages. A subset of these cysts – intraductal papillary mucinous neoplasms (IPMNs) – has the potential for malignant degeneration into pancreatic adenocarcinoma. However, the clinical significance and optimal management of small cysts (< 1 cm in diameter) remains a topic of debate. We conducted a systematic review and meta-analysis to evaluate the growth and progression characteristics of small (< 1 cm in diameter) cystic lesions of the pancreas.
We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review question was, “In patients with small (< 1 cm) IPMN and undefined cysts of the pancreas, what is the risk of disease progression into pancreatic adenocarcinoma?” A health sciences librarian conducted literature searches on November 14, 2022. The databases searched included Ovid MEDLINE(R) ALL, from 1946 to February 27, 2020, Embase, Web of Science, and Google Scholar. We included all types of case series and cohort studies which included > 10 patients. Studies that described small cystic lesions of the pancreas, measuring less than 1 cm on cross-sectional imaging, were considered for inclusion.
22 studies met inclusion criteria for this systematic review (Figure 1), describing various aspects of small cystic lesions. The study period ranged from 1988 to 2019 and included a total of 10,270 patients. Cystic lesions < 1 cm were reported in 2,790 patients. Seven studies reported data regarding change in size, including 613 patients. 22 of 118 cysts (18.6%) increased in size during surveillance. 78 of 118 cysts (66.1%) exhibited no change in size. 40 cysts shrank or disappeared during follow-up, but one of the studies did not include a discrete denominator. One study reported 222 of 388 (57.2%) cysts < 1 cm remained stable in size after 5 years of follow up. Five studies reported data regarding the development of worrisome features. 68 of 1197 lesions (5.7%) developed worrisome features or high-risk stigmata during follow-up.
While 5.7% of lesions exhibit growth and development of worrisome features (ranging from 2.0%-16.1%), the majority (94.3%) of these small cysts do not. These data support the current surveillance regimens recommended by major society guidelines.