Protocolo diagnóstico de las lesiones sólidas y quísticas pancreáticas

  1. Lariño-Noia, J.
  2. Iglesias-García, J.
  3. Domínguez-Muñoz, J.E.
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2020

Series: 13

Issue: 9

Pages: 507-511

Type: Article

DOI: 10.1016/J.MED.2020.05.023 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Abstract

Resumen Las lesiones sólidas pancreáticas (LSP) suelen condicionar síntomas y corresponder en su mayoría a un cáncer de páncreas. La tomografía axial computarizada (TAC) y los estudios por resonancia (RM) suelen ser las técnicas de imagen inicialmente empleadas. La ecoendoscopia es la técnica ideal en el diagnóstico diferencial, identificando lesiones de pequeño tamaño, valorando su resecabilidad y permitiendo además una biopsia de las mismas. La mayoría de las lesiones quísticas pancreáticas (LQP) son incidentales. La clave radica en identificar aquellas potencialmente malignas como las lesiones mucinosas (tumor papilar mucinoso intraductal - TPMI y cistoadenoma mucinoso). La ecoendoscopia y los estudios por RM, incluyendo la colangiopancreatorresonancia (CPRM) son las técnicas empleadas para caracterizarlas. El manejo terapéutico se establece según la presencia de determinados signos de alarma, existiendo varias guías internacionales que sirven de ayuda en la toma de decisiones. La edad y las comorbilidades del paciente deben considerarse a la hora de valorar la cirugía o el seguimiento Solid Pancreatic Lesions (SPL) are usually symptomatic and mainly corresponding to a pancreatic cancer. CT scan and MR imaging are often performed as initial evaluation. Endoscopic Ultrasound (EUS) is the best technique for the differential diagnosis of a SPL. EUS allows the detection of small lesions, assess the resectability of the tumor and perform EUS-guided sampling for obtaining a final diagnosis in most cases. The vast majority of Cystic Pancreatic Lesions (CPL) are incidentally found. The main point is to distinguish benign from potential malignant lesions, as mucinous CPL (Intraductal Papillary Mucinous Neoplasm – IPMN and Mucinous Cystic Neoplasm). EUS and MRI with Cholangiopancreatography (MRCP) are the best techniques in the characterization. Therapeutic approach is mainly based on the presence of warning signs, being the international guidelines an important tool for the management. Age and comorbidities must be taken into account in therapeutic decision (surgical treatment vs surveillance).

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