Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy

Abstract

Purpose To determine the effects of patient age and comorbidity level on life expectancy (LE) benefits associated with imaging follow-up of Bosniak IIF renal cysts and pancreatic side-branch (SB) intraductal papillary mucinous neoplasms (IPMNs). Materials and Methods A decision-analytic Markov model to evaluate LE benefits was developed. Hypothetical cohorts with varied age (60-80 years) and comorbidities (none, mild, moderate, or severe) were evaluated. For each finding, LE projections from two strategies were compared: imaging follow-up and no imaging follow-up. Under follow-up, it was assumed that cancers associated with the incidental finding were successfully treated before they spread. For patients without follow-up, mortality risks from Bosniak IIF cysts (renal cell carcinoma) and SBIPMNs (pancreatic ductal adenocarcinoma) were incorporated. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. Results In the youngest, healthiest cohorts (age, 60 years; no comorbidities), projected LE benefits from follow-up were as follows: Bosniak IIF cyst, 6.5 months (women) and 5.8 months (men); SBIPMN, 6.4 months (women) and 5.3 months (men). Follow-up of Bosniak IIF cysts in 60-year-old women with severe comorbidities yielded a LE benefit of 3.9 months; in 80-year-old women with no comorbidities, the benefit was 2.8 months, and with severe comorbidities the benefit was 1.5 months. Similar trends were observed in men and for SBIPMN. Results were sensitive to the performance of follow-up for cancer detection; malignancy risks; and stage at presentation of malignant, unfollowed Bosniak IIF cysts. Conclusion With progression of age and comorbidity level, follow-up of low-risk incidental findings yields increasingly limited benefits for patients. RSNA, 2018 Online supplemental material is available for this article.

Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity Level

“…Relative to the present analysis, using similar decisionanalytic methods, we found modest, although comparatively greater, benefits of imaging follow-up in the setting of two distinct types of incidental findings in individuals with advanced age and comorbidities [19]. We projected that 80year-old women with severe comorbidities who underwent 5 years of imaging follow-up for a Bosniak IIF cyst could gain up to 1.5 months under similar assumptions of "perfect" cancer control [19]. We projected that a similar cohort of women with incidental side-branch intraductal papillary mucinous neoplasms could gain up to 1.2 months [19].…”

“…To provide context for estimates presented in the present analysis, in the setting of colorectal cancer screening programs (with colonoscopy) beginning at age 50, researchers have projected LE gains ranging from 90 to 100 days per person screened, using mathematical models [22]. Relative to the present analysis, using similar decisionanalytic methods, we found modest, although comparatively greater, benefits of imaging follow-up in the setting of two distinct types of incidental findings in individuals with advanced age and comorbidities [19]. We projected that 80year-old women with severe comorbidities who underwent 5 years of imaging follow-up for a Bosniak IIF cyst could gain up to 1.5 months under similar assumptions of "perfect" cancer control [19].…”

“…We projected that 80year-old women with severe comorbidities who underwent 5 years of imaging follow-up for a Bosniak IIF cyst could gain up to 1.5 months under similar assumptions of "perfect" cancer control [19]. We projected that a similar cohort of women with incidental side-branch intraductal papillary mucinous neoplasms could gain up to 1.2 months [19].…”

“…We validated our approach for the addition of cancer mortality to cancer-free life tables using 1999 to 2001 decennial life tables, as further detailed in the Appendix [19,20].…”

The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

“…Besides variations in screen frequency and starting age, models used different surveillance tests; varying between magnetic resonance imaging (MRI), Endoscopic Ultrasound (EUS), Computed tomography (CT), a combination of imaging tests or a hypothetical test. Two papers assumed a 100% sensitive test for PanIN3 and PC detection 11,17 . Although unrealistic, this model provides insight in the maximal gain of screening in a hypothetical optimal scenario.…”