🔮Pancreatic cysts: What's in the Juice by #YanBi from #MayoFL #IMPACT #gitwitter

🎯Pancreatic Cysts Incidence 📈with ↑imaging

🌟90% of P-Cysts are IPMNs (Intraductal Papillary Mucinous Neoplasms)
-70% IPMNs are BD-IPMN (branch duct)
-30% IPMNs are MD-IPMN (main duct)

🔮Benign cysts (observation/drainage/sx)
- Pseudocyst
- Serous cystadenoma

⁉️Pre-malignant (observation/sx)
- IPMN
- MCN (mucinous cystic neoplams)

🦀Malignant (sx)
- Cystic neuroendocrine tumor (CNET)
- Solid pseudopapillary neoplasm (SPN)
- Cystic degeneration of PDAC

🎯Cyst fluid CEA >192 distinguishes between mucinous vs. non-mucinous BUT not malignant vs. non-malignant ($$$)

🌟Cyst fluid glucose <50 costs significantly ↓ & does the same as CEA

🎖️CEA and glucose can be combined for even higher sensitivity and specificity

🔮Common P-Cyst fluid genetic markers:

1⃣ SCA (serous cyst adenoma): VHL
2⃣ SPN (serous pseudopapillary neoplasm): CTNNB1
3⃣ IPMN: GNAS
4⃣ MCN: None

This article summarizes the several high-risk and worrisome features that should be considered during the initial evaluation of a P-Cyst. See 🖼️↓

wjgnet.com/1007-9327/full…

🔥New developments in P-Cysts🌎:
1⃣Imaging:
‼️FDG-PET Is More Sensitive And Specific In Predicting PC Malignancy when compared to CT and MRI

❣️BUT FAPI-PET is better!!
(FAP: fibroblast activation protein)

DOI: 10.2967/jnumed.120.253062

2⃣EUS:
🎯Contrast Enhanced Harmonic EUS is more effective in predicting Malignant IPMN

🎯Confocal laser endomicroscopy (CLE) can accurately differentiate Mucinous from Non-Mucinous lesions. Needle-Based CLE is also gaining traction.

3⃣Pathology: Microforceps is in development

4⃣Biomarkers: Several are in works, including promising DNA-biomarkers

5⃣Treatment: Currently, there is insufficient evidence to support the routine use of cyst ablation, BUT novel techniques are in the works❣️