title: Natural history of asymptomatic pancreatic cystic neoplasms.
abstract: BACKGROUND
  The management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history.
  
  
  OBJECTIVE
  This study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis.
  
  
  METHODS
  Asymptomatic cysts were identified from a prospectively maintained database. Sequential cross-sectional imaging studies were assessed, and results of endoscopic ultrasound-guided aspiration were co-analysed.
  
  
  RESULTS
  A total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow-up was 5.1 years [interquartile range (IQR): 4.1-6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6-1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7-1.6 cm) during follow-up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0-3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0-4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post-presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions.
  
  
  CONCLUSIONS
  Asymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis.
authors: Department of General Surgery, Section of Surgical Oncology and Hepatopancreatobiliary Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors: Gareth
authors: G
authors: Morris-Stiff
authors: Gavin A
authors: GA
authors: Falk
authors: Sricharan
authors: S
authors: Chalikonda
authors: R Matthew
authors: RM
authors: Walsh
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D018450:Disease Progression; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology* / Q000628:therapy; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000473:pathology* / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D057832:Watchful Waiting
references: AJR Am J Roentgenol. 2005 Jan;184(1):20-3
references: 15615944
references: J Gastrointest Surg. 2008 Apr;12(4):645-50
references: 18097728
references: J Comput Assist Tomogr. 2004 Jan-Feb;28(1):117-22
references: 14716244
references: Surgery. 2008 Oct;144(4):677-84; discussion 684-5
references: 18847654
references: Surgery. 2010 Jan;147(1):13-20
references: 19767045
references: Endoscopy. 2010 Dec;42(12):1077-84
references: 21120776
references: Clin Gastroenterol Hepatol. 2008 Jul;6(7):815-9; quiz 719
references: 18602036
references: Clin Gastroenterol Hepatol. 2006 Apr;4(4):460-8
references: 16616351
references: Int J Surg. 2011;9(8):655-8
references: 21925294
references: Gastrointest Endosc. 2009 Oct;70(4):690-699.e6
references: 19647240
references: Ann Surg. 2004 Jun;239(6):788-97; discussion 797-9
references: 15166958
references: Dig Dis Sci. 2007 Oct;52(10):2653-9
references: 17404855
references: Abdom Imaging. 2011 Apr;36(2):196-205
references: 20473669
references: J Am Coll Surg. 2010 Aug;211(2):205-15
references: 20670858
references: Surgery. 2010 Oct;148(4):638-44; discussion 644-5
references: 20797749
references: AJR Am J Roentgenol. 2008 Sep;191(3):802-7
references: 18716113
references: J Am Coll Surg. 2011 Apr;212(4):590-600; discussion 600-3
references: 21463795
references: World J Gastrointest Surg. 2010 Oct 27;2(10):368-72
references: 21160846
references: Am J Gastroenterol. 2008 Jul;103(7):1657-62
references: 18564119
references: Int J Pancreatol. 1995 Dec;18(3):197-206
references: 8708390
references: Surgery. 2005 Oct;138(4):672-9; discussion 679-80
references: 16269296
references: Surgery. 2005 Oct;138(4):665-70; discussion 670-1
references: 16269295
references: Ann Surg. 2006 Oct;244(4):572-82
references: 16998366
references: Pancreas. 2004 Apr;28(3):241-6
references: 15084964
references: Clin Gastroenterol Hepatol. 2010 Feb;8(2):213-9
references: 19835989
references: Arch Surg. 2009 May;144(5):448-54
references: 19451487
references: Pancreatology. 2010;10(2-3):144-50
references: 20484954
references: Gut. 2008 Mar;57(3):339-43
references: 17660227
references: J Gastrointest Surg. 2012 Jan;16(1):89-102; discussion 102-3
references: 22065319
references: JOP. 2008 Sep 02;9(5):612-7
references: 18762692
references: J Am Coll Surg. 2012 Jan;214(1):33-45
references: 22055585
references: Ann Surg. 2007 Oct;246(4):644-51; discussion 651-4
references: 17893501
references: Am J Gastroenterol. 2010 Sep;105(9):2079-84
references: 20354507
references: Ann Surg. 2004 May;239(5):651-7; discussion 657-9
references: 15082969
references: J Clin Gastroenterol. 2003 Mar;36(3):261-5
references: 12590239
references: Pancreatology. 2006;6(1-2):17-32
references: 16327281
references: J Gastrointest Surg. 2009 Mar;13(3):405-15
references: 19130153
references: J Surg Oncol. 2009 Oct 1;100(5):372-4
references: 19267387
references: Cancer. 2006 Aug 25;108(4):239-49
references: 16691573
references: J Gastrointest Surg. 2012 Feb;16(2):258-67; discussion 266
references: 22089952