Pancreatic Cysts : Diagnosis

Hans Gerdes (center), Director of the Gastrointestinal Endoscopy Unit, is one of many specialists who evaluate pancreatic cysts. Hans Gerdes (center), Director of the Gastrointestinal Endoscopy Unit, is one of many specialists who evaluate pancreatic cysts.

When you come to Memorial Sloan Kettering, your doctor will review previous imaging and medical data from your primary care or referring physician and discuss whether you have a family history of pancreatic or other gastrointestinal cancers.

We also perform a combination of laboratory, diagnostic imaging, and pathology tests to thoroughly evaluate your pancreatic cyst(s). Your tests results are reviewed by our multidisciplinary team of specialists, which meets weekly and collaborates to develop an individualized treatment plan.

Blood Tests

Some blood tests provide evidence that may help to determine whether you have a benign or precancerous cyst.

Carcinogenic Antigen (CEA)

Levels of this protein in the blood or cyst fluid may be higher in people with a precancerous cyst. However, CEA levels can also rise in response to noncancerous conditions such as pancreatitis.

Liver (Hepatic) Function Test

This test is used to measure levels of bilirubin (a waste product created in the liver) and liver enzymes, which can increase when a cyst or tumor blocks the bile duct.

Diagnostic Imaging

Your doctor may also recommend imaging tests to evaluate a pancreatic cyst.

CT Angiography/Triphasic CT

This noninvasive scan is used to identify the precise location and size of a cyst or tumor. Our doctors inject a contrast dye before scanning to obtain a highly accurate image of three areas of the pancreas and surrounding blood vessels. This method reduces the amount of radiation required to obtain an image and improves the accuracy of the scan to a level approaching that of more-invasive procedures.

MRI/Magnetic Resonance Cholangiopancreatography (MRCP)

MRI scans help doctors learn more about the size and structure of a pancreatic cyst. A type of MRI called MRCP may be used to see inside the pancreatic ducts, where precancerous cysts called intraductal papillary mucinous neoplasms (IPMNs) occur.

Endoscopic Ultrasound (EUS)

Our doctors may recommend EUS when imaging and laboratory findings are inconclusive. In EUS, doctors insert a thin scope through the mouth and into the stomach while the patient is under anesthesia. A small ultrasound probe at the tip of the scope emits sound waves that bounce through the walls of the stomach onto the adjacent pancreas, providing highly detailed pictures of the pancreas. The endoscope used in EUS can also be used to remove pancreatic cells and cyst fluid for a biopsy.

The success rate and accuracy of this delicate procedure often varies among centers.(1) Gastroenterologists at Memorial Sloan Kettering are highly experienced with EUS, and perform more than 100 of these procedures each year to evaluate pancreatic cysts and remove cyst fluid for biopsies.

Biopsy

Your doctor may also recommend a biopsy to look for CEA and other substances that are often found in precancerous cysts. Fluid or cells may be obtained with EUS using a technique called fine needle aspiration. In this procedure, a gastroenterologist inserts a thin needle into the scope, which is then placed into the cyst with the guidance of ultrasound images. Fluid and cells are removed through the needle and analyzed by a pathologist.

Pathologists at Memorial Sloan Kettering are leaders in the analysis of pancreatic cyst fluid. We also maintain a library of tissue and fluid samples that is used to conduct research to identify biomarkers for pancreatic cysts and cancer. Biomarkers are measurable substances such as proteins and genes that can help doctors distinguish between benign and precancerous cysts and may indicate whether a precancerous growth will become malignant.

Pancreatic Cyst Registry

Memorial Sloan Kettering is a leader in research on the development and progression of pancreatic cysts. Our Pancreatic Cyst Registry includes diagnostic information from more than 2,000 patients with pancreatic cysts who were evaluated and treated at Memorial Sloan Kettering. Information from this database will help us improve our ability to predict which pancreatic cysts are likely to become cancerous and require immediate treatment.

If you have a family history of gastrointestinal cancer, your doctor may refer you to our Pancreatic Tumor Registry, which collects data that may help to identify pancreatic cancer earlier and to develop more-effective treatments for the disease.

  1. Moparty B and Bhutani M. The role of endoscopic ultrasound in cystic pancreatic tumor treatment. Gastroenterology & Hepatology. 2006 Aug;2(8):578-83.