Diagnosing Pancreatic Cysts

NYU Langone doctors perform a physical exam, assess your symptoms and risk factors, and perform imaging tests to diagnose pancreatic cysts. They may also order a biopsy of the cyst or blood tests. A team of radiologists, gastroenterologists, surgical oncologists, and pathologists specializing in pancreatic conditions review your test results, ensuring the most precise diagnosis.

Symptoms of Pancreatic Cysts

Many pancreatic cysts do not cause any symptoms and are discovered by chance or incidentally during imaging tests performed for unrelated conditions.

However, when a pancreatic cyst grows, it can lead to symptoms, including the following:

• Abdominal pain: a cyst may press on nearby organs or nerves, causing persistent or intermittent abdominal pain. This pain typically occurs in the upper abdomen and can radiate to the back.
• Nausea and vomiting: a large cyst can press on the stomach or bile duct, leading to feelings of nausea and vomiting.
• Jaundice: if a cyst blocks the bile duct, it can prevent bile from flowing normally, leading to jaundice, which is a yellowing of the skin and eyes.
• Loss of appetite: pancreatic cysts may cause a feeling of fullness after eating only a small amount of food.
• Weight loss, which may occur if the cyst affects digestion or appetite.

Causes and Risk Factors for Pancreatic Cysts

The exact causes of most types of pancreatic cysts are not fully understood. However, these factors and conditions are associated with their development:

• Pancreatitis: pseudocysts are almost always a direct result of acute or chronic pancreatitis, which is inflammation of the pancreas.
• Genetic syndromes: in some cases, pancreatic cysts can be linked to genetic syndromes, such as Von Hippel-Lindau disease, a rare inherited disorder that causes tumors and cysts to grow in various parts of the body.
• Age: the prevalence of pancreatic cysts tends to increase with age, likely due to incidental discovery during imaging for other age-related conditions.

Diagnosing Pancreatic Cysts at NYU Langone

An accurate diagnosis is the cornerstone of effective management for pancreatic cysts. Our doctors use advanced imaging to identify the type of pancreatic cyst and guide your treatment plan.

MRI Scan

MRI provides detailed images of soft tissues and can help our doctors determine the size, shape, location, and internal characteristics of a cyst. An MRI scan can also detect any features that may suggest the cyst is at risk of becoming cancerous.

Magnetic Resonance Cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is an imaging test that focuses on the pancreatic duct and bile duct systems. These scans help our radiologists assess the cyst's size, location, and internal features. It can detect the presence of septations (internal walls) or solid components and whether the main pancreatic duct is dilated. These findings indicate an increased risk of cancer.

CT scan

Our doctors may use a CT scan for the initial detection of pancreatic cysts or when an MRI is not feasible. For example, some people who have medical implants like pacemakers cannot have an MRI.

Endoscopic Ultrasound

An endoscopic ultrasound, or EUS, is an advanced procedure that combines endoscopy with ultrasound technology. During an EUS, a thin, flexible tube with a tiny ultrasound probe at its tip is guided down your throat into your digestive tract. This allows our specialists to obtain highly detailed images of the pancreas and surrounding structures.

Biopsy with Cyst Fluid Analysis

A unique advantage of EUS is the ability to perform a fine needle aspiration or a biopsy where a small needle is passed through the endoscope to collect fluid from the cyst. This fluid is then analyzed for mucin content, tumor markers such as carcinoembryonic antigen (CEA), and the presence of abnormal or cancerous cells. This analysis helps doctors differentiate benign cysts from precancerous or malignant cysts and tailor the most appropriate management plan.

Our specialists perform EUS with precision, ensuring accurate sampling and minimal discomfort.

Blood Tests

A blood test cannot directly determine the kind of cyst, but it may be performed to assess overall pancreatic function or to check for specific tumor markers. Testing for tumor markers often yields less specific results than cyst fluid analysis does.