Approach to Cystic Pancreatic Lesions

Pancreatic cystic lesions (PCLs) have different morphological and histological features, characterized by peculiar imaging findings. Prevalence is about 2.6% and increases with age. These lesions may be inflammatory or proliferative, ranging from tumors with benign to malignant behavior. In most cases, the diagnosis of PCLs is incidental due to the increasing use of cross-sectional imaging and the improvement of imaging quality. Given the malignant potential of some of these lesions, an accurate and reproducible multidisciplinary approach is essential. As the first step, it is important to analyze the clinical history of the patient to exclude an inflammatory process. After clinical evaluation, imaging studies allow us to identify the morphological features and stratify the risk of malignant potential. Non-invasive imaging findings will guide the decision to eventually perform endoscopic ultra-sonography with fine-needle aspiration (EUS-FNA) when appropriate. Regarding management, patients with benign lesions should undergo surveillance, while surgical treatment is recommended for lesions with signs of malignant degeneration.