Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm
Purpose To assess the long-term malignancy risk of incidental small pancreatic cysts. Materials and methods In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cy...
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| Veröffentlicht in: | European radiology 2022-05, Vol.32 (5), p.3369-3376 |
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| creator | Nakhaei, Masoud Bligh, Mathew Chernyak, Victoria Bezuidenhout, Abraham F. Brook, Alexander Brook, Olga R. |
| description | Purpose
To assess the long-term malignancy risk of incidental small pancreatic cysts.
Materials and methods
In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and |
| doi_str_mv | 10.1007/s00330-021-08428-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2623324705</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2654825246</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-c9cb031f41c1ebe75838f76c3108424283ae3b34ad3013ab65de224f64b310673</originalsourceid><addsrcrecordid>eNp9kc1OHSEUx0nTplevfQEXhqQbNyhwmI-7NKZ-JCZu7JowzBmdG4aZAhNz36bP0icr16vWunDFgfzODw5_Qg4FPxGcV6eRcwDOuBSM10rWTHwie0KBZCLvP7-pF2Q_xjXnfCVU9ZUsoOACqlLtkc21t32L3iIdOzoZbwOa1Ftqc4mBtnPo_T11o79nCcNAu9G58ZHNE-195lOPPkX62KeHfPCkSsb9J9rEDMTBOJd96cF4Kv_8tsMB-dIZF_Hb87okPy9-3J1fsZvby-vzsxtmgReJ2ZVtOIhOCSuwwaqooe6q0sJ2LpmnBoPQgDIt5JlMUxYtSqm6UjUZKStYkuOddwrjrxlj0kMfLTpnPI5z1LKUAFJVvMjo93foepyDz6_LVKFqWUhVZkruKBvGGAN2egr9YMJGC663wehdMDoHo5-C0SI3HT2r52bA9rXlJYkMwA6I0_bHMfy7-wPtX9fbmUY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2654825246</pqid></control><display><type>article</type><title>Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Nakhaei, Masoud ; Bligh, Mathew ; Chernyak, Victoria ; Bezuidenhout, Abraham F. ; Brook, Alexander ; Brook, Olga R.</creator><creatorcontrib>Nakhaei, Masoud ; Bligh, Mathew ; Chernyak, Victoria ; Bezuidenhout, Abraham F. ; Brook, Alexander ; Brook, Olga R.</creatorcontrib><description>Purpose
To assess the long-term malignancy risk of incidental small pancreatic cysts.
Materials and methods
In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the “small pancreatic cyst” group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison “no cyst” group.
Results
The “small pancreatic cyst” group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the “no cyst” group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (
p
values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the “small pancreatic cyst” group, with a cancer rate of 0.9 (95% CI 0.1–3.1) cases per 1,000 patient-years. In the “no cyst” cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2–3.1) cases per 1,000 patient-years (
p
= 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (
p
= 0.09).
Conclusion
The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst.
Key Points
• After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts.
• Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-021-08428-1</identifier><identifier>PMID: 35013764</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Asymptomatic ; Cancer ; Cysts ; Diagnostic Radiology ; Female ; Follow-Up Studies ; Hepatobiliary-Pancreas ; Humans ; Imaging ; Incidence ; Incidental Findings ; Internal Medicine ; Interventional Radiology ; Magnetic resonance imaging ; Male ; Malignancy ; Medicine ; Medicine & Public Health ; Middle Aged ; Neuroradiology ; Pancreatic cancer ; Pancreatic Cyst - diagnostic imaging ; Pancreatic Cyst - epidemiology ; Pancreatic Cyst - pathology ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatic Neoplasms - epidemiology ; Pancreatic Neoplasms - pathology ; Patients ; Radiology ; Retrospective Studies ; Ultrasound</subject><ispartof>European radiology, 2022-05, Vol.32 (5), p.3369-3376</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2021</rights><rights>2021. The Author(s), under exclusive licence to European Society of Radiology.</rights><rights>The Author(s), under exclusive licence to European Society of Radiology 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-c9cb031f41c1ebe75838f76c3108424283ae3b34ad3013ab65de224f64b310673</citedby><cites>FETCH-LOGICAL-c305t-c9cb031f41c1ebe75838f76c3108424283ae3b34ad3013ab65de224f64b310673</cites><orcidid>0000-0002-7074-8909</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-021-08428-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-021-08428-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35013764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakhaei, Masoud</creatorcontrib><creatorcontrib>Bligh, Mathew</creatorcontrib><creatorcontrib>Chernyak, Victoria</creatorcontrib><creatorcontrib>Bezuidenhout, Abraham F.</creatorcontrib><creatorcontrib>Brook, Alexander</creatorcontrib><creatorcontrib>Brook, Olga R.</creatorcontrib><title>Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Purpose
To assess the long-term malignancy risk of incidental small pancreatic cysts.
Materials and methods
In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the “small pancreatic cyst” group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison “no cyst” group.
Results
The “small pancreatic cyst” group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the “no cyst” group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (
p
values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the “small pancreatic cyst” group, with a cancer rate of 0.9 (95% CI 0.1–3.1) cases per 1,000 patient-years. In the “no cyst” cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2–3.1) cases per 1,000 patient-years (
p
= 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (
p
= 0.09).
Conclusion
The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst.
Key Points
• After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts.
• Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.</description><subject>Aged</subject><subject>Asymptomatic</subject><subject>Cancer</subject><subject>Cysts</subject><subject>Diagnostic Radiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatobiliary-Pancreas</subject><subject>Humans</subject><subject>Imaging</subject><subject>Incidence</subject><subject>Incidental Findings</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neuroradiology</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Cyst - diagnostic imaging</subject><subject>Pancreatic Cyst - epidemiology</subject><subject>Pancreatic Cyst - pathology</subject><subject>Pancreatic Neoplasms - diagnostic imaging</subject><subject>Pancreatic Neoplasms - epidemiology</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Patients</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Ultrasound</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kc1OHSEUx0nTplevfQEXhqQbNyhwmI-7NKZ-JCZu7JowzBmdG4aZAhNz36bP0icr16vWunDFgfzODw5_Qg4FPxGcV6eRcwDOuBSM10rWTHwie0KBZCLvP7-pF2Q_xjXnfCVU9ZUsoOACqlLtkc21t32L3iIdOzoZbwOa1Ftqc4mBtnPo_T11o79nCcNAu9G58ZHNE-195lOPPkX62KeHfPCkSsb9J9rEDMTBOJd96cF4Kv_8tsMB-dIZF_Hb87okPy9-3J1fsZvby-vzsxtmgReJ2ZVtOIhOCSuwwaqooe6q0sJ2LpmnBoPQgDIt5JlMUxYtSqm6UjUZKStYkuOddwrjrxlj0kMfLTpnPI5z1LKUAFJVvMjo93foepyDz6_LVKFqWUhVZkruKBvGGAN2egr9YMJGC663wehdMDoHo5-C0SI3HT2r52bA9rXlJYkMwA6I0_bHMfy7-wPtX9fbmUY</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Nakhaei, Masoud</creator><creator>Bligh, Mathew</creator><creator>Chernyak, Victoria</creator><creator>Bezuidenhout, Abraham F.</creator><creator>Brook, Alexander</creator><creator>Brook, Olga R.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7074-8909</orcidid></search><sort><creationdate>202205</creationdate><title>Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm</title><author>Nakhaei, Masoud ; Bligh, Mathew ; Chernyak, Victoria ; Bezuidenhout, Abraham F. ; Brook, Alexander ; Brook, Olga R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-c9cb031f41c1ebe75838f76c3108424283ae3b34ad3013ab65de224f64b310673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Asymptomatic</topic><topic>Cancer</topic><topic>Cysts</topic><topic>Diagnostic Radiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hepatobiliary-Pancreas</topic><topic>Humans</topic><topic>Imaging</topic><topic>Incidence</topic><topic>Incidental Findings</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neuroradiology</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Cyst - diagnostic imaging</topic><topic>Pancreatic Cyst - epidemiology</topic><topic>Pancreatic Cyst - pathology</topic><topic>Pancreatic Neoplasms - diagnostic imaging</topic><topic>Pancreatic Neoplasms - epidemiology</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Patients</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakhaei, Masoud</creatorcontrib><creatorcontrib>Bligh, Mathew</creatorcontrib><creatorcontrib>Chernyak, Victoria</creatorcontrib><creatorcontrib>Bezuidenhout, Abraham F.</creatorcontrib><creatorcontrib>Brook, Alexander</creatorcontrib><creatorcontrib>Brook, Olga R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakhaei, Masoud</au><au>Bligh, Mathew</au><au>Chernyak, Victoria</au><au>Bezuidenhout, Abraham F.</au><au>Brook, Alexander</au><au>Brook, Olga R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2022-05</date><risdate>2022</risdate><volume>32</volume><issue>5</issue><spage>3369</spage><epage>3376</epage><pages>3369-3376</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Purpose
To assess the long-term malignancy risk of incidental small pancreatic cysts.
Materials and methods
In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the “small pancreatic cyst” group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison “no cyst” group.
Results
The “small pancreatic cyst” group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the “no cyst” group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (
p
values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the “small pancreatic cyst” group, with a cancer rate of 0.9 (95% CI 0.1–3.1) cases per 1,000 patient-years. In the “no cyst” cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2–3.1) cases per 1,000 patient-years (
p
= 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (
p
= 0.09).
Conclusion
The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst.
Key Points
• After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts.
• Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35013764</pmid><doi>10.1007/s00330-021-08428-1</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7074-8909</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1084 |
| ispartof | European radiology, 2022-05, Vol.32 (5), p.3369-3376 |
| issn | 1432-1084 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2623324705 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Asymptomatic Cancer Cysts Diagnostic Radiology Female Follow-Up Studies Hepatobiliary-Pancreas Humans Imaging Incidence Incidental Findings Internal Medicine Interventional Radiology Magnetic resonance imaging Male Malignancy Medicine Medicine & Public Health Middle Aged Neuroradiology Pancreatic cancer Pancreatic Cyst - diagnostic imaging Pancreatic Cyst - epidemiology Pancreatic Cyst - pathology Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - epidemiology Pancreatic Neoplasms - pathology Patients Radiology Retrospective Studies Ultrasound |
| title | Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm |
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