Ardeshna DR, Cao T, Rodgers B, Onongaya C, Jones D, Chen W, Koay EJ, Krishna SG. Recent advances in the diagnostic evaluation of pancreatic cystic lesions. World J Gastroenterol 2022; 28(6): 624-634 [PMID: 35317424 DOI: 10.3748/wjg.v28.i6.624]
Corresponding Author of This Article
Somashekar G Krishna, AGAF, FACG, FASGE, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 14, 2022; 28(6): 624-634 Published online Feb 14, 2022. doi: 10.3748/wjg.v28.i6.624
Recent advances in the diagnostic evaluation of pancreatic cystic lesions
Devarshi R Ardeshna, Troy Cao, Brandon Rodgers, Chidiebere Onongaya, Dan Jones, Wei Chen, Eugene J Koay, Somashekar G Krishna
Devarshi R Ardeshna, Chidiebere Onongaya, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Troy Cao, Brandon Rodgers, College of Medicine, Ohio State University, Columbus, OH 43210, United States
Dan Jones, James Molecular Laboratory, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Wei Chen, Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Eugene J Koay, Department of GI Radiation Oncology, The University of Texas MD Anderson, Houston, TX77030, United States
Somashekar G Krishna, Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Ardeshna DR, Cao T, Rodgers B, Onongaya C, Krishna SG performed the majority of the literature search, writing, and preparation of tables/figures; Jones D, Chen W, Koay EJ and Krishna SG provided input in the writing process and review of the final manuscript.
Conflict-of-interest statement: Krishna SG is the principal investigator of an investigator-initiated study. The study in part is funded by a grant to The Ohio State University Wexner Medical Center from Mauna Kea Technologies, Paris, France.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Somashekar G Krishna, AGAF, FACG, FASGE, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Received: May 29, 2021 Peer-review started: May 29, 2021 First decision: June 22, 2021 Revised: July 30, 2021 Accepted: January 19, 2022 Article in press: January 19, 2022 Published online: February 14, 2022 Processing time: 256 Days and 6.6 Hours
Abstract
Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.
Core Tip: Pancreatic cystic lesions (PCLs) are highly prevalent. It is critical to accurately diagnose PCLs and risk stratify them to guide management. Current diagnostic techniques are suboptimal; hence, recent investigations have focused on developing, refining, and validating novel technologies for accurately diagnosing specific cyst type and ascertaining high-risk lesions for malignancy. Radiomics, cyst-fluid biomarkers, confocal laser endomicroscopy and microforceps biopsy hold the promise of accurately diagnosing PCLs and improving their management.
