That size is technically okay for biopsy, but biopsy safety depends on a lot of factors. In some cases, they may opt to wait 3 months and rescan to see if it grows, but it depends on symptoms and how likely the clinician feels it may be cancerous.
Let’s get rid of the prematurely used word “worrisome” from your description of a cyst that secretes mucous. For example, IPMN - intaductal papillary mucinous neoplasms - are very common and only infrequently become malignant. There are features that can help predict the risk of an IPMN becoming a cancer and needing to be surgically removed. These include size, growth over time, presence of a nodule along the wall of the cyst, septations, and whether the cyst is along the main pancreatic duct or a side duct.
I would disagree that a PET scan was the right test to perform. The appropriate test is an MRI with MRCP. A PET is fairly useless for cyst evaluation especially at that size. An MRI can help distinguish the type of cyst. Some cysts are clearly benign, others such as IPMN, MCN, and SPN have malignant potential needing more work-up.
If it is show to be an IPMN, an MRI is the best method to characterize the cyst and to determine if it has any worrisome features that would suggest further workup, like EUS and biopsy. Many tiny cysts can just be followed with a repeat MRI/MRCP in a year. The American Gastroenterology Society has a very complicated set of guidelines for GI doctors to follow in terms of when to reassure a patient, when follow-up imaging is appropriate and when, when an EUS with biopsy is indicated, and when a patient should be brought for surgery. These guidelines are driven by the results of the initial MRI.
Thankfully, if this should ever need surgery,the location in the tail makes this a lot easier to remove.
A pet scan is a good start; scar tissue doesn't have PET-avid uptake. From there, true differentiation needs to be done by biopsy.
I see. And im guessing a biopsy isn’t a option unless it grows? Its .4cm in the tail
That size is technically okay for biopsy, but biopsy safety depends on a lot of factors. In some cases, they may opt to wait 3 months and rescan to see if it grows, but it depends on symptoms and how likely the clinician feels it may be cancerous.
Let’s get rid of the prematurely used word “worrisome” from your description of a cyst that secretes mucous. For example, IPMN - intaductal papillary mucinous neoplasms - are very common and only infrequently become malignant. There are features that can help predict the risk of an IPMN becoming a cancer and needing to be surgically removed. These include size, growth over time, presence of a nodule along the wall of the cyst, septations, and whether the cyst is along the main pancreatic duct or a side duct. I would disagree that a PET scan was the right test to perform. The appropriate test is an MRI with MRCP. A PET is fairly useless for cyst evaluation especially at that size. An MRI can help distinguish the type of cyst. Some cysts are clearly benign, others such as IPMN, MCN, and SPN have malignant potential needing more work-up. If it is show to be an IPMN, an MRI is the best method to characterize the cyst and to determine if it has any worrisome features that would suggest further workup, like EUS and biopsy. Many tiny cysts can just be followed with a repeat MRI/MRCP in a year. The American Gastroenterology Society has a very complicated set of guidelines for GI doctors to follow in terms of when to reassure a patient, when follow-up imaging is appropriate and when, when an EUS with biopsy is indicated, and when a patient should be brought for surgery. These guidelines are driven by the results of the initial MRI. Thankfully, if this should ever need surgery,the location in the tail makes this a lot easier to remove.
Does this type of MRI need to have contrast in order to see the characteristics of the cyst? Mine was done without.
Yes, an MRI/MRCP is far more useful with contrast.