Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect

Frank H. Miller*, Camila Lopes Vendrami, Hannah S. Recht, Cecil G. Wood, Pardeep Mittal, Rajesh N. Keswani, Helena Gabriel, Amir A. Borhani, Paul Nikolaidis, Nancy A. Hammond

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


The widespread use of high–spatial-resolution cross-sectional imaging has led to an increase in detection of incidental pancreatic cystic lesions. These lesions are a diverse group, ranging from indolent and premalignant lesions to invasive cancers. The diagnosis of sev-eral of these lesions can be suggested on the basis of their imaging appearance, while many other lesions require follow-up imaging and/or aspiration. The smaller cystic lesions, often branch-duct in-traductal papillary mucinous neoplasms, have overlapping imaging characteristics that make diagnostic assessment of the natural history and malignancy risk confusing. Expert panels have developed societal guidelines, based on a consensus, for surveillance of these lesions. However, these guidelines are often inconsistent and are constantly evolving as additional scientific data are accumulated. Identification of features associated with increased risk of malignancy is important for proper management. The concept of field defect, whereby pancreatic adenocarcinoma develops at a site different from the site of the pancreatic cyst, adds to the complexity of screening guidelines. As a result of the differences in guidelines, key stakeholders (eg, radiologists, gastroenterologists, and surgeons) must review and come to a consensus regarding which guideline, or combination of guidelines, to follow at their individual institutions. Standardized reporting and macros are helpful for ensuring the uniformity of interpretations. Radiologists play a critical role in the detection and characterization of pancreatic cystic lesions, in the follow-up recommendations for these lesions, and in the detection of associated cancer.

Original languageEnglish (US)
Pages (from-to)87-105
Number of pages19
Issue number1
StatePublished - Jan 1 2022

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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