Purpose of review: Pancreatic cystic neoplasms are increasingly identified and their management remains uncertain. Recent studies demonstrate an evolving clinical approach.
Recent findings: The vast majority of asymptomatic pancreatic cysts without concerning clinical or imaging features can be observed without surgery. Clinical predictors for malignancy at surgery include male sex, age above 50 years, weight loss, and high cyst fluid carcinoembryonic antigen (CEA), but these factors are insufficient for patient selection. Endoscopic ultrasound (EUS)-guided fine needle aspiration with cyst fluid analysis for risk stratification and selective resection appears the most cost-effective approach. In addition to CEA, DNA analysis, differential protein expression, and proteomic studies of cyst fluid may be helpful in differentiating cystic lesions in selected patients. EUS-guided ethanol lavage of cysts resulted in regression; this method may have a role in treatment in the future. More future research investigating the safety of this procedure, technique modifications, and choice of agent is needed.
Summary: The approach to incidentally discover pancreatic cystic lesions is challenging due to the difficulty in preoperative definitive lesion characterization. Recently developed diagnostic and treatment strategies show promise for improved patient outcomes.