Zystische Veränderungen des Pankreas in der Diagnose des Pankreaskarzinoms: Vergleich einer Hochrisikogruppe mit einem Normalkollektiv

Malignant neoplasms are by now the second largest group of causes of death. Pancreatic cancer is among the top ten most common types of cancer. The 5- year survival rate is below 5%. There are different ways of classifying neoplasms of the pancreas. Adenocarcinomas account for the largest share (85%) of all pancreatic neoplasms. Other entities include serous cystadenomas, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms and pseudocysts, which are the most common cystic lesion. The familial pancreatic cancer is rare and occurs most frequently as pancreatic carcinoma syndrome. Several registers record patients with familial pancreatic cancer (NFPTR in Baltimore, EUROPAC in Liverpool, FaPaCa in Marburg). There are various screening programs for affected families and there is no consensus about the algorithm of screening those patients yet. In this study, the prevalence of cystic lesions of the pancreas in high risk individuals compared to a normal population was investigated. Furthermore, it was to be studied how those lesions present, if the lesions change over time and to what degree the interobserver agreement presents. For this purpose, an analysis sheet was created. Via this sheet images of MRI and MRCP were evaluated. Two groups of patients were studied. The first group was recruited from the screening program for high risk individuals of the FaPaCa register Marburg. The images of these patients were evaluated by two examiners. The second group consisted of patients who had an MRI of the upper abdomen in 2009/2010. These pictures were examined by one observer. This group was subdivided into patients with and without pancreatic pathology based on the indication for the MRI. There were cystic lesions to be found in 43.1% of high risk individuals, 18.3% of patients without pancreatic pathology and 42.7% of patients with pancreatic pathology. 41.8% of the lesions in the high risk individuals had contact with the main pancreatic duct, respectively 72.2% in the group of patients with pancreatic pathology and 50% in the group without pancreatic pathology. Multilocular cysts made up 17.2% of cysts in the group of high risk individuals, 58.3% of lesions in the group of patients with pancreatic pathology and 21.4% in the group of patients without pancreatic pathology. The evaluation of follow-up studies showed that in 57.4% there was no change. The interobserver agreement in the analysis of high risk individuals was very good. The prevalence of asymptomatic cysts in this study and in other studies is comparable. The challenge is for one the transferability of the finding to the general population and secondly the question of how to deal with such incidental findings. In the absence of malignant predictors, a conservative management strategy is often recommended. High-risk patients frequently show cystic lesions, simple cysts as well as multilocular cystic lesions such as IPMN. Further studies with follow-ups over a longer period of time are needed to gain clarity in the management of those lesions.