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Pancreatic Incidentaloma: take it or leave it?

Volume 5 - Issue 2

Akkaraphorn Deeprasertvit*

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    • Police General Hospital, Thailand

    *Corresponding author: Akkaraphorn Deeprasertvit, HPB Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, Thailand

Received: May 25, 2018;   Published: June 06, 2018

DOI: 10.26717/BJSTR.2018.05.001162

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“Incidentaloma” has been generally used to describe an asymptomatic lesion incidentally detected by imaging studies or biochemical diagnostic tests. The first report about “Pancreatic Incidentaloma” (PI) was published in Russian literature in 2001. Incidental pancreatic cysts series have been gradually reported since them. Nowadays we have better developed radiologic studies such as ultrasonography, CT, and MRI, which have been widely used. This explains how we could detect more PIs. The main issues we are concerned with are the lesion characteristics if we have options to safely observe or to remove it, which depends on risk of malignancy. Choosing proper investigations for PI is a challenging issue to take the risk of either surgery or untreated pancreatic cancer. However, despite decreased operative risk due to better technologies and operative techniques, postoperative morbidity is still as high as 40%. The basic principle for preoperative assessment consists of avoidance of unnecessary surgery, especially when the lesion is less likely to be malignant, and respectability determination, if the lesion contains malignant features. The patient’s information, history taking, physical examination, investigations (pancreatic protocol CT/MRI/MRCP) play an important role in making a diagnosis. Besides these, there are many other useful tools, such as serum markers, endoscopic ultrasound, and staging laparoscopy. Pancreatic mass workup remains a challenging clinical task, but can be approached by a thoughtful structural approach.

Abbreviations: PI: Pancreatic Incidentaloma, FDA: Food and Drug Administration, ASCO: American Society of Clinical Oncology, AIP: Auto Immune Pancreatitis, OS: Overall Survival, PFS: Progression-Free Survival, US: Ultrasonography, MDCT: Multiple Detector Computed Tomography, SMA: Superior Mesenteric Artery, EUS: Endoscopy Ultrasonography

Abstract| Introduction| Biomarkers| Radiology| Management| Conclusion| References|