Progress in diagnosis and treatment of pancreatic cystic neoplasms_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Wei ,  LUO Shiqiao

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

LUO Shiqiao, Email: shiqiaoluo@qq.com

Keywords：

pancreatic cystic neoplasms; clinical manifestation; diagnosis; treatment; follow-up

DOI：

10.7507/1007-9424.202207034

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the research progress in the diagnosis and treatment of pancreatic cystic neoplasms (PCNs). Method The guidelines and literatures related to the diagnosis and treatment of PCNs were collected and reviewed. Results At present, there was still no clear method to distinguish the types of PCNs and their benign and malignant, and there was still a dispute between domestic and foreign guidelines on the diagnosis and treatment of PCNs. Conclusion Clinical researchers still need to carry out more research, provide higher quality evidence, resolve the disputes existing in different guidelines, standardize the diagnosis and treatment process of PCNs, thus, PCNs can be identified early, diagnosed accurately and intervened in time.

Citation： LI Wei, LUO Shiqiao. Progress in diagnosis and treatment of pancreatic cystic neoplasms. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 249-255. doi: 10.7507/1007-9424.202207034 Copy

1.	中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南(2015). 中国实用外科杂志, 2015, 35(9): 955-959.
2.	Zerboni G, Signoretti M, Crippa S, et al. Systematic review and meta-analysis: prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology, 2019, 19(1): 2-9.
3.	Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery, 2012, 152(3 Suppl 1): S4-S12. doi: 10.1016/j.surg.2012.05.033.
4.	Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 2006, 6(1-2): 17-32.
5.	Sharib J, Esserman L, Koay EJ, et al. Cost-effectiveness of consensus guideline based management of pancreatic cysts: the sensitivity and specificity required for guidelines to be cost-effective. Surgery, 2020, 168(4): 601-609.
6.	Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology, 2015, 148(4): 819-822; quize12-13.
7.	van Huijgevoort NCM, Del Chiaro M, Wolfgang CL, et al. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol, 2019, 16(11): 676-689.
8.	European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.
9.	Lennon AM, Ahuja N, Wolfgang CL. AGA Guidelines for the management of pancreatic cysts. Gastroenterology, 2015, 149(3): 825. doi: 10.1053/j.gastro.2015.05.062.
10.	Elta GH, Enestvedt BK, Sauer BG, et al. ACG Clinical Guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol, 2018, 113(4): 464-479.
11.	Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology, 2009, 251(1): 175-184.
12.	Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol, 2010, 7(10): 754-773.
13.	World Gastroenterology Organisation. WGO Practice Guideline: pancreatic systic lesions. https://www.worldgastroenterology.org/guidelines/pancreatic-cystic-lesions/pancreatic-cystic-lesions-english/.
14.	Hozaka Y, Kurahara H, Oi H, et al. Clinical utility and limitation of diagnostic ability for different degrees of dysplasia of intraductal papillary mucinous neoplasms of the pancreas using ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography. Cancers (Basel), 2021, 13(18): 4633. doi: 10.3390/cancers13184633.
15.	Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology, 2004, 126(5): 1330-1336.
16.	Akisik MF, Sandrasegaran K, Aisen AA, et al. Dynamic secretin-enhanced MR cholangiopancreatography. Radiographics, 2006, 26(3): 665-677.
17.	Swensson J, Zaheer A, Conwell D, et al. Secretin-enhanced MRCP: how and why- AJR expert panel narrative review. AJR Am J Roentgenol, 2021, 216(5): 1139-1149.
18.	Yang D, Trindade AJ, Yachimski P, et al. Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin Gastroenterol Hepatol, 2019, 17(8): 1587-1596.
19.	Westerveld DR, Ponniah SA, Draganov PV, et al. Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis. Endosc Int Open, 2020, 8(5): E656-E667. doi: 10.1055/a-1119-6543.
20.	Crinò SF, Bernardoni L, Brozzi L, et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointest Endosc, 2019, 90(6): 933-943.
21.	Larghi A, Manfrin E, Fabbri C, et al. Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. Gastrointest Endosc, 2019, 90(5): 784-792.
22.	Krishna SG, Hart PA, Malli A, et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. clin gastroenterol hepatol, 2020, 18(2): 432-440.
23.	Krishna SG, Hart PA, DeWitt JM, et al. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video). Gastrointest Endosc, 2020, 91(3): 551-563.
24.	Lan C, Li X, Wang X, et al. A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms. Cancer Biol Med, 2018, 15(1): 70-78.
25.	Goh BK, Teo JY, Allen JC, et al. Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms. Pancreatology, 2016, 16(5): 888-892.
26.	Zhuge X, Zhou H, Chen L, et al. The association between serum ferritin levels and malignant intraductal papillary mucinous neoplasms. BMC Cancer, 2021, 21(1): 1253. doi: 10.1186/s12885-021-08986-z.
27.	Sun LQ, Peng LS, Guo JF, et al. Validation of serum tumor biomarkers in predicting advanced cystic mucinous neoplasm of the pancreas. World J Gastroenterol, 2021, 27(6): 501-512.
28.	Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, 2017, 17(5): 738-753.
29.	Dumonceau JM, Deprez PH, Jenssen C, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline-Updated January 2017. Endoscopy, 2017, 49(7): 695-714.
30.	Cizginer S, Turner BG, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas, 2011, 40(7): 1024-1028.
31.	Gaddam S, Ge PS, Keach JW, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc, 2015, 82(6): 1060-1069.
32.	Thornton GD, McPhail MJ, Nayagam S, et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology, 2013, 13(1): 48-57.
33.	Pitman MB, Yaeger KA, Brugge WR, et al. Prospective analysis of atypical epithelial cells as a high-risk cytologic feature for malignancy in pancreatic cysts. Cancer Cytopathol, 2013, 121(1): 29-36.
34.	Jabbar KS, Verbeke C, Hyltander AG, et al. Proteomic mucin profiling for the identification of cystic precursors of pancreatic cancer. J Natl Cancer Inst, 2014, 106(2): djt439. doi: 10.1093/jnci/djt439.
35.	Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc, 2009, 69(6): 1095-1102.
36.	Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med, 2011, 3(92): 92ra66. doi: 10.1126/scitranslmed.3002543.
37.	Kanda M, Sadakari Y, Borges M, et al. Mutant TP53 in duodenal samples of pancreatic juice from patients with pancreatic cancer or high-grade dysplasia. Clin Gastroenterol Hepatol, 2013, 11(6): 719-730.
38.	Dmitriev K, Kaufman AE, Javed AA, et al. Classification of pancreatic cysts in computed tomography images using a random forest and convolutional neural network ensemble. Med Image Comput Comput Assist Interv, 2017, 10435: 150-158.
39.	Cheng S, Shi H, Lu M, et al. Radiomics analysis for predicting malignant potential of intraductal papillary mucinous neoplasms of the pancreas: comparison of CT and MRI. Acad Radiol, 2022, 29(3): 367-375.
40.	Xie H, Ma S, Guo X, et al. Preoperative differentiation of pancreatic mucinous cystic neoplasm from macrocystic serous cystic adenoma using radiomics: preliminary findings and comparison with radiological model. Eur J Radiol, 2020, 122: 108747. doi: 10.1016/j.ejrad.2019.108747.
41.	Shen X, Yang F, Yang P, et al. A contrast-enhanced computed tomography based radiomics approach for preoperative differentiation of pancreatic cystic neoplasm subtypes: a feasibility study. Front Oncol, 2020, 10: 248. doi: 10.3389/fonc.2020.00248.
42.	Kuwahara T, Hara K, Mizuno N, et al. Usefulness of deep learning analysis for the diagnosis of malignancy in intraductal papillary mucinous neoplasms of the pancreas. Clin Transl Gastroenterol, 2019, 10(5): 1-8.
43.	Nguon LS, Seo K, Lim JH, et al. Deep learning-based differentiation between mucinous cystic neoplasm and serous cystic neoplasm in the pancreas using endoscopic ultrasonography. Diagnostics (Basel), 2021, 11(6): 1052. doi: 10.3390/diagnostics11061052.
44.	Oh S, Kim YJ, Park YT, et al. Automatic pancreatic cyst lesion segmentation on EUS images using a deep-learning approach. Sensors (Basel), 2021, 22(1): 245. doi: 10.3390/s22010245.
45.	Kim MJ, Choi DW, Choi SH, et al. Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. Br J Surg, 2014, 101(10): 1266-1271.
46.	Canakis A, Law R, Baron T. An updated review on ablative treatment of pancreatic cystic lesions. Gastrointest Endosc, 2020, 91(3): 520-526.
47.	Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas, 2011, 40(3): 364-370.
48.	Fábrega-Foster K, Kamel IR, et al. ACR appropriateness criteria^® pancreatic cyst. J Am Coll Radiol, 2020, 17(5S): S198-S206. doi: 10.1016/j.jacr.2020.01.021.
49.	Nilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology, 2016, 16(6): 1028-1036.
50.	Postlewait LM, Ethun CG, McInnis MR, et al. Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg, 2017, 152(1): 19-25.
51.	Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology, 2012, 12(3): 183-197.
52.	Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis, 2013, 45(9): 703-711.
53.	Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med, 2015, 3(19): 286. doi: 10.3978/j.issn.2305-5839.2015.11.09.
54.	Goh BK. International guidelines for the management of pancreatic intraductal papillary mucinous neoplasms. World J Gastroenterol, 2015, 21(34): 9833-9837.
55.	Megibow AJ, Baker ME, Morgan DE, et al. Management of incidental pancreatic cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol, 2017, 14(7): 911-923.

1. 中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南(2015). 中国实用外科杂志, 2015, 35(9): 955-959.
2. Zerboni G, Signoretti M, Crippa S, et al. Systematic review and meta-analysis: prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology, 2019, 19(1): 2-9.
3. Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery, 2012, 152(3 Suppl 1): S4-S12. doi: 10.1016/j.surg.2012.05.033.
4. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 2006, 6(1-2): 17-32.
5. Sharib J, Esserman L, Koay EJ, et al. Cost-effectiveness of consensus guideline based management of pancreatic cysts: the sensitivity and specificity required for guidelines to be cost-effective. Surgery, 2020, 168(4): 601-609.
6. Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology, 2015, 148(4): 819-822; quize12-13.
7. van Huijgevoort NCM, Del Chiaro M, Wolfgang CL, et al. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol, 2019, 16(11): 676-689.
8. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.
9. Lennon AM, Ahuja N, Wolfgang CL. AGA Guidelines for the management of pancreatic cysts. Gastroenterology, 2015, 149(3): 825. doi: 10.1053/j.gastro.2015.05.062.
10. Elta GH, Enestvedt BK, Sauer BG, et al. ACG Clinical Guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol, 2018, 113(4): 464-479.
11. Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology, 2009, 251(1): 175-184.
12. Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol, 2010, 7(10): 754-773.
13. World Gastroenterology Organisation. WGO Practice Guideline: pancreatic systic lesions. https://www.worldgastroenterology.org/guidelines/pancreatic-cystic-lesions/pancreatic-cystic-lesions-english/.
14. Hozaka Y, Kurahara H, Oi H, et al. Clinical utility and limitation of diagnostic ability for different degrees of dysplasia of intraductal papillary mucinous neoplasms of the pancreas using ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography. Cancers (Basel), 2021, 13(18): 4633. doi: 10.3390/cancers13184633.
15. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology, 2004, 126(5): 1330-1336.
16. Akisik MF, Sandrasegaran K, Aisen AA, et al. Dynamic secretin-enhanced MR cholangiopancreatography. Radiographics, 2006, 26(3): 665-677.
17. Swensson J, Zaheer A, Conwell D, et al. Secretin-enhanced MRCP: how and why- AJR expert panel narrative review. AJR Am J Roentgenol, 2021, 216(5): 1139-1149.
18. Yang D, Trindade AJ, Yachimski P, et al. Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin Gastroenterol Hepatol, 2019, 17(8): 1587-1596.
19. Westerveld DR, Ponniah SA, Draganov PV, et al. Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis. Endosc Int Open, 2020, 8(5): E656-E667. doi: 10.1055/a-1119-6543.
20. Crinò SF, Bernardoni L, Brozzi L, et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointest Endosc, 2019, 90(6): 933-943.
21. Larghi A, Manfrin E, Fabbri C, et al. Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. Gastrointest Endosc, 2019, 90(5): 784-792.
22. Krishna SG, Hart PA, Malli A, et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. clin gastroenterol hepatol, 2020, 18(2): 432-440.
23. Krishna SG, Hart PA, DeWitt JM, et al. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video). Gastrointest Endosc, 2020, 91(3): 551-563.
24. Lan C, Li X, Wang X, et al. A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms. Cancer Biol Med, 2018, 15(1): 70-78.
25. Goh BK, Teo JY, Allen JC, et al. Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms. Pancreatology, 2016, 16(5): 888-892.
26. Zhuge X, Zhou H, Chen L, et al. The association between serum ferritin levels and malignant intraductal papillary mucinous neoplasms. BMC Cancer, 2021, 21(1): 1253. doi: 10.1186/s12885-021-08986-z.
27. Sun LQ, Peng LS, Guo JF, et al. Validation of serum tumor biomarkers in predicting advanced cystic mucinous neoplasm of the pancreas. World J Gastroenterol, 2021, 27(6): 501-512.
28. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, 2017, 17(5): 738-753.
29. Dumonceau JM, Deprez PH, Jenssen C, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline-Updated January 2017. Endoscopy, 2017, 49(7): 695-714.
30. Cizginer S, Turner BG, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas, 2011, 40(7): 1024-1028.
31. Gaddam S, Ge PS, Keach JW, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc, 2015, 82(6): 1060-1069.
32. Thornton GD, McPhail MJ, Nayagam S, et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology, 2013, 13(1): 48-57.
33. Pitman MB, Yaeger KA, Brugge WR, et al. Prospective analysis of atypical epithelial cells as a high-risk cytologic feature for malignancy in pancreatic cysts. Cancer Cytopathol, 2013, 121(1): 29-36.
34. Jabbar KS, Verbeke C, Hyltander AG, et al. Proteomic mucin profiling for the identification of cystic precursors of pancreatic cancer. J Natl Cancer Inst, 2014, 106(2): djt439. doi: 10.1093/jnci/djt439.
35. Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc, 2009, 69(6): 1095-1102.
36. Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med, 2011, 3(92): 92ra66. doi: 10.1126/scitranslmed.3002543.
37. Kanda M, Sadakari Y, Borges M, et al. Mutant TP53 in duodenal samples of pancreatic juice from patients with pancreatic cancer or high-grade dysplasia. Clin Gastroenterol Hepatol, 2013, 11(6): 719-730.
38. Dmitriev K, Kaufman AE, Javed AA, et al. Classification of pancreatic cysts in computed tomography images using a random forest and convolutional neural network ensemble. Med Image Comput Comput Assist Interv, 2017, 10435: 150-158.
39. Cheng S, Shi H, Lu M, et al. Radiomics analysis for predicting malignant potential of intraductal papillary mucinous neoplasms of the pancreas: comparison of CT and MRI. Acad Radiol, 2022, 29(3): 367-375.
40. Xie H, Ma S, Guo X, et al. Preoperative differentiation of pancreatic mucinous cystic neoplasm from macrocystic serous cystic adenoma using radiomics: preliminary findings and comparison with radiological model. Eur J Radiol, 2020, 122: 108747. doi: 10.1016/j.ejrad.2019.108747.
41. Shen X, Yang F, Yang P, et al. A contrast-enhanced computed tomography based radiomics approach for preoperative differentiation of pancreatic cystic neoplasm subtypes: a feasibility study. Front Oncol, 2020, 10: 248. doi: 10.3389/fonc.2020.00248.
42. Kuwahara T, Hara K, Mizuno N, et al. Usefulness of deep learning analysis for the diagnosis of malignancy in intraductal papillary mucinous neoplasms of the pancreas. Clin Transl Gastroenterol, 2019, 10(5): 1-8.
43. Nguon LS, Seo K, Lim JH, et al. Deep learning-based differentiation between mucinous cystic neoplasm and serous cystic neoplasm in the pancreas using endoscopic ultrasonography. Diagnostics (Basel), 2021, 11(6): 1052. doi: 10.3390/diagnostics11061052.
44. Oh S, Kim YJ, Park YT, et al. Automatic pancreatic cyst lesion segmentation on EUS images using a deep-learning approach. Sensors (Basel), 2021, 22(1): 245. doi: 10.3390/s22010245.
45. Kim MJ, Choi DW, Choi SH, et al. Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. Br J Surg, 2014, 101(10): 1266-1271.
46. Canakis A, Law R, Baron T. An updated review on ablative treatment of pancreatic cystic lesions. Gastrointest Endosc, 2020, 91(3): 520-526.
47. Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas, 2011, 40(3): 364-370.
48. Fábrega-Foster K, Kamel IR, et al. ACR appropriateness criteria^® pancreatic cyst. J Am Coll Radiol, 2020, 17(5S): S198-S206. doi: 10.1016/j.jacr.2020.01.021.
49. Nilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology, 2016, 16(6): 1028-1036.
50. Postlewait LM, Ethun CG, McInnis MR, et al. Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg, 2017, 152(1): 19-25.
51. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology, 2012, 12(3): 183-197.
52. Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis, 2013, 45(9): 703-711.
53. Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med, 2015, 3(19): 286. doi: 10.3978/j.issn.2305-5839.2015.11.09.
54. Goh BK. International guidelines for the management of pancreatic intraductal papillary mucinous neoplasms. World J Gastroenterol, 2015, 21(34): 9833-9837.
55. Megibow AJ, Baker ME, Morgan DE, et al. Management of incidental pancreatic cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol, 2017, 14(7): 911-923.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in diagnosis and treatment of pancreatic cystic neoplasms

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