Progression of pancreatic cystic lesions without any risk features is associated with initial cyst size and obesity

Park, Hye Won; Lee, Jong Soo; Park, Seo Young; Kim, Tae Hyup; Lee, Ji Young; Koo, Ja Eun; Bae, Suh Eun; Choe, Jaewon; Chang, Hyo Won; Park, Do Hyun; Bae, Inyoung; Park, Sung Won

doi:10.1111/jgh.14940

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…30,31 Cyst size may be an indicator of PCLs progression. [31][32][33] However, no such association was found in our study. This may be due to the entry criteria of our study which did not include lesions less than 5 mm in length, and short-term period of followup.…”

Section: Discussioncontrasting

confidence: 91%

Opportunistic Detection for Pancreatic Cystic Lesions During Chest Multidetector CT Scans for Lung Cancer Screening

Chen¹,

Yu²,

Wang³

et al. 2021

CMAR

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Purpose The purpose of this study was to analyze the prevalence of and risk factors for incidental pancreatic cystic lesions (PCLs) in the Chinese general population. Furthermore, the association between baseline imaging findings and PCL progression was also investigated. Patients and Methods A total of 9826 individuals who underwent computed tomography (CT) examinations for lung cancer screening between January 1, 2018 and January 1, 2019 were included in this study. The participants’ CT imaging findings and biochemical biomarker levels were reviewed and analyzed. PCLs detected during the screening were followed up for 12 months. Associations between imaging findings and clinical factors with PCL progression were explored. Results PCLs were observed in 172 of the 9826 participants. The crude prevalence of PCLs in total population was 1.75%. In subjects aged >60 years, the prevalence of PCLs was 3.2% (102/3151). The occurrence of PCLs was significantly increased with an increase of age in both men and women (p < 0.001). High-risk PCLsL commonly located in pancreatic head showed extrapancreatic growth, and had high urea levels (p = 0.005, p = 0.015, p = 0.002, respectively) compared with low-risk PCLs. Location in the pancreatic head (odds ratio (OR) = 6.286, 95% confidence interval (CI): 1.842–21.452) and extrapancreatic growth (OR = 4.049, 95% CI: 1.235–13.333) were risk factors for PCL progression. Conclusion PCLs are not uncommon in the Chinese general population. Location in the pancreatic head and extrapancreatic growth are the independent predictors of high-risk of PCLs and PCL progression.

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Section: Discussioncontrasting

confidence: 91%

Opportunistic Detection for Pancreatic Cystic Lesions During Chest Multidetector CT Scans for Lung Cancer Screening

Chen¹,

Yu²,

Wang³

et al. 2021

CMAR

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“…38%) and somewhat larger at diagnosis (14 vs. 12 mm). Initial cyst size and multifocality have been identified as predictors for growth and the development of WFs in both our cohorts and others, 32,[34][35][36][37] and therefore, this difference could (partially) explain why the validation cohort had a higher percentage of patients developing WFs than the development cohort (20% vs. 13%). Nevertheless, both differences are small and therefore may not represent a clinically relevant difference.…”

Section: Discussionmentioning

confidence: 64%

International external validation of a stratification tool to identify branch‐duct intraductal papillary mucinous neoplasms at lowest risk of progression

et al. 2022

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Background Identifying branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMNs) at lowest risk of progression may allow for a reduced intensity of surveillance. Objective We aimed to externally validate the previously developed Dutch‐American Risk stratification Tool (DART‐1; https://rtools.mayo.edu/DART/), which identifies cysts at low risk of developing worrisome features (WFs) or high‐risk stigmata (HRS). Methods Three prospective cohorts of individuals under surveillance for BD‐IPMNs were combined, independent from the original development cohort. We assessed the performance (discrimination and calibration) of DART‐1, a multivariable Cox‐proportional logistic regression model with five predictors for the development of WFs or HRS. Results Of 832 individuals (mean age 77 years, SD 11.5) under surveillance for a median of 40 months (IQR 44), 163 (20%) developed WFs or HRS. DART‐1's discriminative ability (C‐statistic 0.68) was similar to that in the development cohort (0.64–0.72) and showed moderate calibration. DART‐1 adequately estimated the risk for patients in the middle risk quintile, and slightly underestimated it in the lowest quintiles. Their range of predicted versus observed 3‐year risk was 0%–0% versus 0%–3.7% for Q1; 0.3%–0.4% versus 3%–11% for Q2; and 2.6%–3% versus 2.4%–9.8% for Q3. The development of WFs or HRS was associated with pancreatic cancer (p < 0.001). Vice versa, in absence of WFs or HRS, the risk of malignancy was low (0.3%). Conclusions The performance of DART‐1 to predict the development of WFs or HRS in BD‐IPMN was validated in an external international cohort, with a discriminative ability equal as in the development cohort. Risk estimations were most accurate for patients with BD‐IPMNs in the middle risk quintile and slightly underestimated in the lowest quintiles.

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“…A follow-up of pancreatic cystic lesions is necessary due to the risk of development of high-grade dysplasia or invasive carcinoma. A large variation in the rate of progression (size increase or development of WF) of 20%-50% has been reported (13,14). Reported frequency of invasive carcinoma or high-grade dysplasia is also highly variable, in the range of 1%-50% depending on whether the studies were evaluating resected specimens, which likely consist of a disproportionately high number of high-risk lesions (15) or studies evaluating long-term surveillance of low-risk pancreatic cystic lesions (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Pancreatic cysts: can surveillance interval for small low-risk lesions be lengthened?

Chong,

Wee,

Tan

et al. 2024

Acta Radiol

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Background Surveillance of pancreatic cysts are necessary due to risk of malignant transformation. However, reported progression rates to advanced neoplasia are variable and the high frequency of surveillance scans may pose a considerable burden on healthcare resources. Purpose To validate the effectiveness of the Fukuoka Guidelines surveillance regime and determine if a longer surveillance interval can be established. Material and Methods All magnetic resonance imaging (MRI) studies of the pancreas performed at our institution between January 2014 and December 2016 with at least one pancreatic cystic lesion and follow-up MRI or computed tomography (CT) over at least two years were reviewed for size, worrisome feature (WF), and high-risk stigmata (HRS) at diagnosis and follow-up imaging (up to year 6). Reference standards for advanced neoplasia were based on endoscopic ultrasound, fine needle aspiration cytology, or the presence of ≥2 WF or ≥1 HRS on imaging. Comparison of MRI features of progression and outcomes of diagnostic endpoints between lesions <20 mm and ≥20 mm was performed. Results A total of 270 patients were included (201 cysts <20 mm, 69 cysts ≥20 mm). Compared with cysts <20 mm, cysts ≥20 mm were more likely to be associated with WF or HRS (40.6% vs. 12.4%; P ≤0.00001), demonstrate increase in size of ≥5 mm in two years (20.3% vs. 10.9%; P = 0.049), and develop advanced neoplasia (24.6% vs. 0.5%; P <0.00001). Conclusion Pancreatic cysts <20 mm have a low risk of developing WF and HRS and surveillance interval may be lengthened.

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Progression of pancreatic cystic lesions without any risk features is associated with initial cyst size and obesity

Cited by 6 publications

References 27 publications

Opportunistic Detection for Pancreatic Cystic Lesions During Chest Multidetector CT Scans for Lung Cancer Screening

Opportunistic Detection for Pancreatic Cystic Lesions During Chest Multidetector CT Scans for Lung Cancer Screening

International external validation of a stratification tool to identify branch‐duct intraductal papillary mucinous neoplasms at lowest risk of progression

Pancreatic cysts: can surveillance interval for small low-risk lesions be lengthened?

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