Incidentalomas of the pancreas

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis which has not appreciably changed over the past decades despite advances in surgical and medical therapies. Most patients present with advanced disease and are not amenable to surgical extirpation. Even with intended curative resection, long-term survival is rare as PDAC is likely systemic very early in the disease process. There are currently no valid screening tools for PDAC but an increasing number of pancreatic lesions are detected due to the ubiquitous use of abdominal imaging in the workup for other diseases. A pancreatic incidental finding may be an opportunity for early diagnosis of a pancreatic malignancy. Conversely, however, many incidentally discovered pancreatic lesions are of little clinical consequence and pancreatic surgery has a high associated morbidity. Thus the management of a pancreatic incidentaloma is a medical quandary. In this article, we discuss the various incidentally discovered pancreatic lesions, with particular attention to the risk of pancreatic malignancy and potential management strategies.