Incidental Findings in the Pancreas (and Elsewhere): Putting Our Patients (and Ourselves) in a Difficult Situation
Authors: Russell P. Harris
Journal: Annals of Internal Medicine (2015)

Ideas and Opinions2 June 2015Incidental Findings in the Pancreas (and Elsewhere): Putting Our Patients (and Ourselves) in a Difficult SituationRussell P. Harris, MD, MPHRussell P. Harris, MD, MPHFrom University of North Carolina, Chapel Hill, North Carolina.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0590 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The American Gastroenterological Association (AGA) has released new guidelines on the management of asymptomatic neoplastic pancreatic cysts (1). Although specialists generally make the decisions guided by these specific recommendations, the general problem of how to evaluate incidental findings will resonate with many generalists like me. The guidelines are needed because the rapid growth in the number of sensitive abdominal computed tomography (CT) and magnetic resonance imaging (MRI) studies (2), many of them ordered by generalists, has led to a marked increase in incidental pancreatic cysts (3, 4). The AGA has taken a bold and welcome stand in backing away from ...References1. Vege SS, Ziring B, Jain R, Moayyedi P. American Gastroenterological Association Institute guidelines for management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015 [Forthcoming]. CrossrefGoogle Scholar2. Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA. 2012;307:2400-9. [PMID: 22692172] doi:10.1001/jama.2012.5960 CrossrefMedlineGoogle Scholar3. Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191:802-7. [PMID: 18716113] doi:10.2214/AJR.07.3340 CrossrefMedlineGoogle Scholar4. de Jong K, Nio CY, Hermans JJ, Dijkgraaf MG, Gouma DJ, van Eijck CH, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol. 2010;8:806-11. [PMID: 20621679] doi:10.1016/j.cgh.2010.05.017 CrossrefMedlineGoogle Scholar5. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7:754-73. [PMID: 20889105] doi:10.1016/j.jacr.2010.06.013 CrossrefMedlineGoogle Scholar6. Scheiman JM, Hwang JH, Moayyedi P. American Gastroenterological Association technical review on the diagnosis and management of pancreatic cysts. Gastroenterology. 2015 [Forthcoming]. CrossrefGoogle Scholar7. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al; International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17-32. [PMID: 16327281] CrossrefMedlineGoogle Scholar8. Tanaka M, Fernández-delCastillo C, Adsay V, Chari S, Falconi M, Jang JY, et al; International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183-97. [PMID: 22687371] doi:10.1016/j.pan.2012.04.004 CrossrefMedlineGoogle Scholar9. Harris RP, Wilt TJ, Qaseem A; High Value Task Force of the American College of Physicians. A value framework for cancer screening: advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162:712-7. doi:10.7326/M14-2327 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Russell P. Harris, MD, MPHAffiliations: From University of North Carolina, Chapel Hill, North Carolina.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0590.Corresponding Author: Russell P. Harris, MD, MPH, Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King Boulevard, CB 7590, University of North Carolina, Chapel Hill, NC 27599; e-mail, rharris@med.unc.edu.Author Contributions: Conception and design: R.P. Harris.Analysis and interpretation of the data: R.P. Harris.Drafting of the article: R.P. Harris.Critical revision of the article for important intellectual content: R.P. Harris.Final approval of the article: R.P. Harris.Statistical expertise: R.P. Harris.Administrative, technical, or logistic support: R.P. Harris.Collection and assembly of data: R.P. Harris.This article was published online first at www.annals.org on 30 March 2015. 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