ACR Appropriateness Criteria® Pancreatic Cyst
ACR Appropriateness Criteria® Pancreatic Cyst
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DOI：
10.1016/j.jacr.2020.01.021
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发表时间：
2020-05-01
影响因子：
4.5
通讯作者：
Carucci, Laura R.
中科院分区：
文献类型：
--
作者：
Fabrega-Foster, Kelly;Kamel, Ihab R.;Carucci, Laura R.
在针对不相关适应症进行的影像学研究中越来越多地发现偶然的胰腺囊肿，并且这些研究可能无法完全表征。由于与肿瘤性胰腺囊肿相关的恶性变性以及相关的胰腺腺癌的风险较小，因此充分的形态学特征至关重要。对于所有胰腺囊肿，大小和形态都决定了治疗方法。具体而言，对特征（例如胰腺导管通讯以及是否存在令人担忧的特征或高风险特征）的成像检测具有重要的管理意义。本出版物中的建议确定了适当的初始影像学研究，以进一步评估在非专用影像学研究中偶然发现的胰腺囊肿。这些建议旨在最大限度地提高诊断信息的产量，以便更好地对胰腺囊肿进行风险分层并协助指导未来的管理。美国放射学会适当性标准是针对特定临床状况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对来自同行评审期刊的当前医学文献进行广泛分析，并应用成熟的方法（兰德/加州大学洛杉矶分校适当性方法和建议评估、制定和评估或 GRADE 分级）来评估特定临床情况的影像和治疗程序的适当性。在证据缺乏或模棱两可的情况下，专家意见可以补充现有证据以建议成像或治疗。
Incidental pancreatic cysts are increasingly detected on imaging studies performed for unrelated indications and may be incompletely characterized on these studies. Adequate morphological characterization is critical due to the small risk of malignant degeneration associated with neoplastic pancreatic cysts, as well as the risk of associated pancreatic adenocarcinoma. For all pancreatic cysts, both size and morphology determine management. Specifically, imaging detection of features, such as pancreatic ductal communication and presence or absence of worrisome features or high-risk stigmata, have important management implications. The recommendations in this publication determine the appropriate initial imaging study to further evaluate a pancreatic cyst that was incidentally detected on a nondedicated imaging study. The recommendations are designed to maximize the yield of diagnostic information in order to better risk-stratify pancreatic cysts and assist in guiding future management.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.