Bechien U Wu1, Kartik Sampath2, Christopher E Berberian2, Karl K Kwok1, Brian S Lim3, Kevin T Kao4, Andrew Q Giap5, Anne E Kosco6, Yasir M Akmal7, Andrew L Difronzo7, Wei Yu8, Eunis W Ngor8. 1. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. 2. Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. 3. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Gastroenterology, Kaiser Permanente, Riverside, California, USA. 4. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Gastroenterology, Kaiser Permanente, Downey, California, USA. 5. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Gastroenterology, Kaiser Permanente, Orange County, Kraemer Medical Center, Kraemer, California, USA. 6. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. 7. 1] Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA [2] Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. 8. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Abstract
OBJECTIVES: Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN. METHODS: We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features. RESULTS: We identified 1,815 patients with confirmed PCN. A total of 53 (2.9%) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4% per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95% confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1%), intermediate (1-5%), and high (9-14%) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing). CONCLUSIONS: Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.
OBJECTIVES:Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN. METHODS: We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features. RESULTS: We identified 1,815 patients with confirmed PCN. A total of 53 (2.9%) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4% per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95% confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1%), intermediate (1-5%), and high (9-14%) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing). CONCLUSIONS: Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.
Authors: Nadav Sahar; Anthony Razzak; Zaheer S Kanji; David L Coy; Richard Kozarek; Andrew S Ross; Michael Gluck; Michael Larsen; Shayan Irani; S Ian Gan Journal: Surg Endosc Date: 2017-12-29 Impact factor: 4.584
Authors: Anne Marie Lennon; Christopher L Wolfgang; Marcia Irene Canto; Alison P Klein; Joseph M Herman; Michael Goggins; Elliot K Fishman; Ihab Kamel; Matthew J Weiss; Luis A Diaz; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Ralph H Hruban Journal: Cancer Res Date: 2014-06-12 Impact factor: 12.701
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