Cystic pancreatic neoplasms: what we need to know and new perspectives

Abstract Pancreatic cystic lesions (PCLs) include a broad spectrum of entities, which greatly differ in their malignant potential and may provide a diagnostic challenge. PCLs can be categorised into: pseudocysts; common cystic neoplasms; uncommon cystic neoplasms and tumours with cystic degeneration. Large lesions are usually possible to differentiate, but small lesions’ characterisation is often not possible. This means that many pancreatic cysts remain undetermined and guidelines are needed for follow-up and management. It is important to make distinction between mucinous cystic neoplasms (MCN) and intraductal pancreatic mucinous neoplasms (IPMN), because all MCN should be resected whereas there is time for observation in specific cases of side branch IPMN. With regards to IPMN, guidelines have established features associated with increased risk of malignancy: the “worrisome” features and high-risk stigmata. It should be considered that the presence of an IPMN may portend an increased risk of invasive pancreatic cancer in a different site of the pancreas. The assessment of PCLs should provide imaging features such as cyst morphology or presence of duct communication, and clinical findings including cystic fluid analysis to improve diagnostic accuracy. Radiomics represents an emerging field of interest that could add some information in the future for the differential diagnosis and follow-up of these lesions. The aim of this study was to define a diagnostic approach to PCLs according to the latest guidelines; a review of the latest developments in radiomics regarding PCLs was also carried out.