Una review open access su Best Practice & Research Clinical Gastroenterology, che aggiorna su burden clinico, incidenza e criteri di inquadramento delle lesioni cistiche del pancreas.
Le lesioni cistiche pancreatiche, sempre più spesso riscontro incidentale all’imaging, raggiungono una prevalenza fino al 13–18% negli adulti asintomatici e comprendono un ampio spettro che va da pseudocisti infiammatorie e cisti sierose benigne a neoplasie mucinose e IPMN con potenziale evoluzione maligna.
La sfida è stratificare correttamente il rischio: evitare chirurgia inutile nelle cisti a basso rischio, senza perdere l’occasione di trattare precocemente le forme premaligne, integrando imaging evoluto, citologia e marcatori molecolari in percorsi condivisi tra gastroenterologi, radiologi, endoscopisti e chirurghi.
#EBGH #cistipancreatiche #pancreas #gastroenterologia #endoscopia #radiologia
A cura di: Sara Nikolic, Riccardo Pellegrini, Marco Del Chiaro, Gabriele Capurso.
Epidemiology, classification and clinical burden of pancreatic cystic lesions
Sara Nikolic, Gabriele Capurso et al.
NDR: SI TRATTA DI UN MAGNIFICO NUMERO DI BEST PRACTICE. MERITO DEI NUOVI EDITOR, FACCIORUSSO E MACHICADO. GRAZIE ANTONIO!
https://www.sciencedirect.com/journal/best-practice-and-research-clinical-gastroenterology/vol/81/suppl/C
Abstract
Pancreatic cystic neoplasms (PCNs), once considered rare, are increasingly detected due to advances in imaging, with prevalence estimates ranging from 13 % to nearly 50 % and rising with age. They comprise a heterogeneous group, including intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), solid pseudopapillary neoplasms (SPNs), cystic neuroendocrine tumors, and pseudocysts. Their biological behavior differs substantially: SCNs and pseudocysts are usually benign, MCNs and IPMNs may progress to cancer, and SPNs generally require resection. Accurate classification is therefore essential, as misdiagnosis may lead to overtreatment with surgical complications or undertreatment with missed malignant transformation.
Epidemiological studies link PCNs to age, metabolic syndrome, diabetes, and smoking, with emerging associations to autoimmune pancreatitis, chronic kidney disease, and fatty pancreas. IPMNs are the most frequent subtype, with risk of progression influenced by cyst size, multifocality, obesity, and tobacco exposure. Management requires balancing oncological risk with patient-specific factors such as comorbidities, age, and life expectancy. While surgery eliminates malignant potential, it carries relevant morbidity and mortality. Conversely, long-term surveillance imposes psychological stress, healthcare resource use, and financial costs.
As their incidence grows, PCNs have become a major clinical and healthcare challenge. Cost-effectiveness analyses favor risk-adapted surveillance over systematic resection, emphasizing the importance of personalized strategies that reduce overtreatment while ensuring timely intervention for high-risk lesions.
Introduction
Once considered rare and often overlooked, pancreatic cystic neoplasms (PCNs) are now more commonly detected, largely due to the advancements in imaging technologies. Current estimates suggest a prevalence of 18–49 % in the general population, with rates rising notably after the sixth decade of life [[1], [2], [3]]. Despite this epidemiological growth, their biological behavior remains incompletely understood, and what was once considered a homogeneous group is now recognized as a collection of distinct entities with varying biological characteristics.
While some PCNs are benign and require no further intervention when asymptomatic, others serve as precursors to pancreatic cancer or may progress to malignancy, potentially requiring surgical intervention. In this context, accurate differential diagnosis becomes essential. Overly aggressive treatment can lead to unnecessary complications, including diabetes, exocrine insufficiency, or even death [4], whereas failing to identify high-risk lesions may result in missed opportunities for timely intervention, allowing malignancies to progress undetected [5]. This creates a significant clinical burden, not only in terms of physical and psychological strain for patients, but also for clinicians who must navigate complex, individualized decision-making [5]. The rising prevalence of PCNs also places substantial pressure on healthcare systems, demanding more resources for imaging, surveillance, and, in some cases, surgery.
As a result, what was once a relatively obscure entity has now become a real burning issue in pancreatology and daily clinical practice. How should we approach this rising challenge? The aim of this review is to explore this evolving landscape, examining its incidence, risk factors, and clinical implications—not only for individual patients, but also for the broader healthcare system as a whole.
