TY - JOUR
T1 - Systematic review and meta-analysis
T2 - Prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals
AU - Zerboni, Giulia
AU - Signoretti, Marianna
AU - Crippa, Stefano
AU - Falconi, Massimo
AU - Arcidiacono, Paolo Giorgio
AU - Capurso, Gabriele
PY - 2019/1
Y1 - 2019/1
N2 - Background & aims: Pancreatic cystic lesions (PCLs) are frequent incidental findings. As most PCLs require costly diagnostic evaluation and active surveillance, it is important to clarify their prevalence in asymptomatic individuals. We therefore aimed at performing a systematic review and meta-analysis to determine it. Methods: a systematic search was conducted and studies meeting inclusion criteria were included. The prevalence of PCLs was pooled across studies. A random effect model was used with assessment of heterogeneity. Results: 17 studies, with 48,860 patients, were included. Only 3 were prospective; 5 studies were conducted in the US, 7 in Europe, 4 in Asia and 1 in Brazil. The pooled prevalence of PCLs was 8% (95% CI 4–14) with considerable heterogeneity (I 2 = 99.5%). This prevalence was higher in studies of higher quality, examining older subjects, smaller cohorts, and employing MRCP (24.8% vs 2.7% with CT-scan). The pooled rate of PCLs was four times higher in studies conducted in the US than in Asia (12.6% vs 3.1%). 7 studies reported the prevalence of mucinous lesions, with a pooled rate of 4.3% (95% CI 2–10; I 2 = 99.2%), but of 0.7% only for worrisome features or high risk stigmata. Conclusion: The rate of incidentally detected PCLs is of 8%. Mucinous lesions are the most common incidentally detected PCLs, although they rarely present with potential indication for surgery. The observed different rates in the US and other geographic Areas suggest that different protocols might be necessary to help balancing costs and effectiveness of follow-up investigations in asymptomatic subjects.
AB - Background & aims: Pancreatic cystic lesions (PCLs) are frequent incidental findings. As most PCLs require costly diagnostic evaluation and active surveillance, it is important to clarify their prevalence in asymptomatic individuals. We therefore aimed at performing a systematic review and meta-analysis to determine it. Methods: a systematic search was conducted and studies meeting inclusion criteria were included. The prevalence of PCLs was pooled across studies. A random effect model was used with assessment of heterogeneity. Results: 17 studies, with 48,860 patients, were included. Only 3 were prospective; 5 studies were conducted in the US, 7 in Europe, 4 in Asia and 1 in Brazil. The pooled prevalence of PCLs was 8% (95% CI 4–14) with considerable heterogeneity (I 2 = 99.5%). This prevalence was higher in studies of higher quality, examining older subjects, smaller cohorts, and employing MRCP (24.8% vs 2.7% with CT-scan). The pooled rate of PCLs was four times higher in studies conducted in the US than in Asia (12.6% vs 3.1%). 7 studies reported the prevalence of mucinous lesions, with a pooled rate of 4.3% (95% CI 2–10; I 2 = 99.2%), but of 0.7% only for worrisome features or high risk stigmata. Conclusion: The rate of incidentally detected PCLs is of 8%. Mucinous lesions are the most common incidentally detected PCLs, although they rarely present with potential indication for surgery. The observed different rates in the US and other geographic Areas suggest that different protocols might be necessary to help balancing costs and effectiveness of follow-up investigations in asymptomatic subjects.
KW - Incidental
KW - Mucinous
KW - Pancreatic cyst
KW - Prevalence
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U2 - 10.1016/j.pan.2018.11.014
DO - 10.1016/j.pan.2018.11.014
M3 - Article
C2 - 30503370
AN - SCOPUS:85057404472
VL - 19
SP - 2
EP - 9
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 1
ER -