Canadian Association of Radiologists Journal
This paper gives the Canadian perspective in approaching incidental findings in the pancreas, including anatomic variants, fatty atrophy, calcifications, ductal ectasia (dilated duct), and incidental cysts. The paper also acknowledges the unique variety of imaging modalities and limited resources.
The management of pancreatic cysts in America is difficult to follow in Canada, as with a public health care, resource allocation (ie. balancing the cost of imaging with probability of disease) is profoundly important.
Pancreatic cysts are very common, and a vast majority of them are developmental or from prior diseases (ie. benign). This is the recommended Canadian approach:
This recommendation only applies to patient group of age 40-75.
So what if you find an incidental simple pancreatic cyst?
If not concerning (no above features), follow-up IV contrast MR pancreas with MRCP in 1 year. If unchanged, MR follow-up every 2 years (for up to 5 years or until patient reaches age 75, whichever comes first.) If lesion grows by 3mm or develops suspicious qualities: GI service referral.
Initial IV contrast enhanced pancreas MR with MRCP. Follow-up with limited pancreatic cyst exam every 2 years (total of 10 years). If lesion grows by 3mm or develops suspicious qualities: GI service referral.
Refer to GI service; this finding is rare in this age group.
Refer to GI service for endoscopic ultrasound with optional fine needle aspiration! High risk of mucinous neoplasm (known to lead to cancer) or symptomatic pancreatitis.
Diverse pseudomasses in the pancrease, including ductal ectasia, pancreatic cysts, anatomic variants, and lipomatosis are explored. Set guidelines are important in properly investigating the etiologies of the patient's illness without subjecting them in further harm.
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