INCIDENTAL PANCREATIC CYSTS-MAJORITY DO NOT BECOME CANCEROUS

To study the frequency of incidental pancreatic cysts in asymptomatic individuals, the authors of a paper published in Gut performed a magnetic resonance cholangiopancreaticography (MRCP) examination in 1077 participants enrolled in a population-based cohort study.^[1]

Of the original group, 676 people underwent a repeat examination 5 years later. At the time of the initial exam, 49% had at least one cyst ≥ 2 mm in diameter. The yearly incidence of new cysts during the follow-up period was 2.6% per year. The frequency of cysts was strongly related to participants' age (P = .001) but was unrelated to body mass index or gender.

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With the advent of high-resolution scanning equipment, pancreatic cysts are being detected with increasing frequency. This study reveals that almost 50% of asymptomatic individuals with a mean age of 58 years harbored cysts ≥ 2 mm in diameter. Cyst presence was strongly related to age: By 75 years of age, 75% of participants had one or more cysts. This implies that assessing the significance and managing cysts will become an increasing problem in subsequent decades, because the number of older people is increasing rapidly in most countries.

Despite the publication of guidelines concerning the management of pancreatic cysts with respect to the potential risk for pancreatic cancer, surgeons still have difficulty deciding when or when not to operate on patients with these lesions.^[2,3] Of the 1077 persons included in the study, one person whose initial imaging scan did not reveal a cyst went on to develop pancreatic cancer. The cysts detected in this study were mostly small, with a mean cyst size of 5.2 mm, with only 26 cysts (3.8%) being larger than 1 cm.

This study suggests that a large proportion of asymptomatic persons will harbor a small pancreatic cyst but that the threat of pancreatic cancer is low.

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