Pancreatic steatosis in pancreatic cystic neoplasms: insights from a matched case-control study

Aims Pancreatic steatosis has gathered many names within recent years, slowly becoming a feared enemy in pancreatology. Some pancreatic neoplastic cystic lesions, such as intraductal papillary mucinous neoplasm (IPMN), cystic neuroendocrine tumors (NET) and mucinous neoplasms, present a carcinogenetic risk, though it is yet unknown if this risk is increased by the presence or absence of pancreatic steatosis. The primary objective of the study is to determine the prevalence of PS in pancreatic neoplastic cysts and if PS is increased in those lesions that pose a carcinogenetic risk.

Methods A single-center retrospective matched case-control study was conducted on patients diagnosed with pancreatic neoplastic cystic lesion between 2019-2024. We have included patients who had undergone endosonographic and computerized tomography evaluation of pancreatic cysts. We have collected clinical, biochemical and imaging data. Pancreatic steatosis was defined by pancreas-to-spleen attenuation ratio (P/S) under 0.7 by CT evaluation [1]. We have enrolled 22 patients with pancreatic neoplastic cystic lesion. Data from 44 matched cases were collected, adjusted by age, sex, nutritional status and lack of hepato-bilio-pancreatic diseases or major comorbidities (malignancy, sepsis, cardiovascular events).

Results 14 patients out of the 22 patients presented lesions with risk of malignant transformation (IPMN, cystic NET, mucinous neoplastic cyst) and 8 have lesions with no or minimal risk of malignant transformation. 8 out of 22 patients performed EUS with FNA or FNB evaluation indicated by the presence of worrisome features. There was no significant difference between the two groups in regard to P/S ratio (p=0.496) or taking into consideration the presence of PS with values over 0.7 (p=0.573). Additionally, we conducted a subgroup analysis to compare premalignant neoplastic cystic lesions (14 cases) with their corresponding control group (28 cases). Even though no notable differences were found between the 2 subgroups (p=0.113), when analysing pancreatic steatosis in the head, body and tail we could observe that P/S ratio are higher in the tail in patients with premalignant neoplastic cystic compared to control group (p=0.059). This suggests that pancreatic steatosis is more frequently encountered in the tail of the pancreas in patients with premalignant neoplastic cystic lesions compared to general population. There were no significant differences between pancreatic fat ratio in head, body and tail (p=0.399).

Conclusions Even though pancreatic fat content was not significantly different in patients with pancreatic neoplastic cysts compared to general population, future studies are needed to establish if there is a role of this new entity in carcinogenesis.

Publication History

Article published online:
27 March 2025

• References

• 1 Hoogenboom SA, Bolan CW, Chuprin A, Raimondo MT, van Hooft JE, Wallace MB. et al. Pancreatic steatosis on computed tomography is an early imaging feature of pre-diagnostic pancreatic cancer: A preliminary study in overweight patients. Pancreatology 2021; 21 (02): 428-33