The edition · Radiology
After five stable years, low-risk pancreatic cysts carried an 8-year cancer risk under 1%
A 13,269-patient review of reports compared the ACR, Kyoto and European cyst guidelines and followed stable cysts beyond surveillance. Plus photon-counting CT inside coronary stents, what germline variants look like on prostate MRI, and whether the ellipsoid formula is good enough for PSA density.
The edition in brief
In 13,269 patients with pancreatic cysts at one US centre, 1.6% developed cancer or high-grade dysplasia within five years. The ACR, Kyoto and European guidelines predicted this modestly (AUROC 0.62 to 0.66), agreed completely on high-risk cysts, and disagreed on which cysts had worrisome features. Among 1,830 patients whose cysts were stable for five years, eight-year cancer incidence was 0.71%, and 0.46% in those meeting Kyoto criteria to stop surveillance. A single-centre study of 70 patients found photon-counting CT made almost all coronary stents assessable (1.1% nondiagnostic vs 46.8% with conventional CT) and missed no in-stent restenosis, though positive predictive value per stent was 56%. Men with prostate cancer carrying germline pathogenic variants were more likely to have PI-RADS 5 lesions (OR 2.7) and upgrading at prostatectomy (37% vs 20%). The PI-RADS ellipsoid volume matched manual segmentation closely (ICC 0.985) in 328 men, underestimating glands over 80 cc.
Photon-counting CT made nearly every coronary stent assessable
Where photon-counting CT is available, consider it for stent follow-up to rule out restenosis, and confirm positive findings invasively.
Germline variant carriers had more PI-RADS 5 lesions and more upgrading
When a patient carries a prostate cancer germline variant, look harder for extraprostatic extension and expect upgrading.
The ellipsoid formula is good enough for PSA density, except in very large glands
Use the ellipsoid formula for PSA density, with extra care in glands over 80 cc, where it underestimates volume.
Say when a stent cannot be assessed
Report an unassessable stent as nondiagnostic, not as patent by default.
Pancreatic cysts stable for five years carried a low later cancer risk
After five years of stability, consider stating in the report that a low-risk pancreatic cyst meets criteria to discuss stopping surveillance.
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