PANCREATIC CYSTS: FROM DIAGNOSIS TO TREATMENT - A LITERATURE REVIEW

Abstract

The management of pancreatic cysts is complex due to the difficulty in distinguishing between benign, premalignant, and malignant lesions. The aim of this review was to analyze and discuss the main challenges faced in the diagnosis and treatment of pancreatic cysts, seeking to explore new technologies and monitoring protocols. A search for previous studies was carried out on the PubMed and Virtual Health Library (VHL) platforms, and a total of 25 scientific articles were included after applying inclusion and exclusion criteria. Through the studies analyzed, it was observed that diagnostic methods such as magnetic resonance imaging with cholangiopancreatography (MRCP) and computed tomography (CT) are regularly used in the initial evaluation, due to their high sensitivity and ability to characterize suspicious lesions. Endoscopic ultrasound (EUS), associated with cystic fluid aspiration (EUS-FNA) and analysis of tumor markers, such as SPINK1, glucose, MUC5AC, CA 19-9 and CEA, has proven to be a complementary approach to differentiate cysts and guide therapeutic decisions. In this way, technological advances have enabled greater diagnostic accuracy and less invasive treatments. Confocal laser-guided endomicroscopy (nCLE) and molecular analysis of DNA in cystic fluid are examples of tools that aid in the identification of malignant characteristics and risk stratification. For lesions with high-risk characteristics, surgical intervention remains necessary. On the other hand, cases without malignant characteristics can be followed with periodic monitoring by imaging methods, such as CT or MRI. Minimally invasive therapies, such as EUS-guided radiofrequency ablation (EUS-RFA) and EUS-guided chemoablation, have demonstrated efficacy in the treatment of benign and low-risk cysts, reducing the need for surgery. These techniques are also useful in inoperable patients or those with surgical contraindications, offering a safe approach with lower risks of complications. However, despite innovations, challenges such as high costs, limited availability of molecular tests, and difficulties in adherence to surveillance guidelines remain. The lack of standardization in the collection and analysis of cystic fluids also limits the widespread application of these strategies. In addition, low adherence to follow-up recommendations, especially in vulnerable populations, reflects the need for individualized programs. In conclusion, the article highlights that new technologies, combined with evidence-based strategies, have the potential to significantly improve the management of pancreatic cysts. The use of artificial intelligence for image analysis and risk prediction, in addition to combined therapies, appears to be a promising future perspective. However, prospective and long-term studies are needed to broadly validate these approaches.