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Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer.

Lawson RD, Hunt GC, Giap AQ, Krinsky ML, Slezak J, Tang RS, Gonzalez I, Kwong WT, Fehmi SA, Savides TJ - Ann Gastroenterol (2015 Oct-Dec)

Bottom Line: Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up.Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Naval Medical Center, San Diego, California (Robert D. Lawson).

ABSTRACT

Background: The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").

Methods: Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).

Results: After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).

Conclusions: This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.

No MeSH data available.


Related in: MedlinePlus

Patient screening, exclusion, and group assignmentBD-IPMN, branch duct-intraductal papillary mucinous neoplasm; EUS, endoscopic ultrasound; HRG, highest-risk group; IPMN, intraductal papillary mucinous neoplasm; LRG, lowest-risk group
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Figure 1: Patient screening, exclusion, and group assignmentBD-IPMN, branch duct-intraductal papillary mucinous neoplasm; EUS, endoscopic ultrasound; HRG, highest-risk group; IPMN, intraductal papillary mucinous neoplasm; LRG, lowest-risk group

Mentions: A total of 894 patients underwent EUS evaluation of one or more pancreatic cysts identified on CT or MRI during the study period (Fig. 1). Of this number 233 patients were excluded for the following suspected diagnoses: 16 MD-IMPN; 29 MCN; 52 SCN; 40 chronic pancreatitis; 35 pseudocyst; 3 history of pancreatic cancer; 1 with von Hippel-Lindau. 57 were excluded for inadequate follow up. Following these exclusions 661 patients comprised the cohort including 218 patients from Kaiser Permanente, Anaheim Medical Center, California; 148 patients from Kaiser Permanente, San Diego Medical Center/Kaiser Foundation Hospital, California; 235 patients from the University of California, San Diego, California; and 60 patients from the Veterans Administration Medical Center, La Jolla, California. Females comprised 55.8%; average age was 67.4 years; and pancreatic cysts were predominantly asymptomatic (67%). Compared to the LRG, patients in the HRG were more often male (53.6% vs 38.4%, P=0.0001), older (68.7 years vs. 66.5 years, P=0.0051), followed for a shorter period of time (3.7 years vs. 4.1 years, P= 0.0013), more often symptomatic (46.4% vs. 24.8%, P<0.0001) and more likely to undergo surgical resection (14.4% vs. 3.5%, P=0.0001). The cohort was followed for an average of 3.8 years, ranging between 3 days (patients diagnosed with pancreatic cancer at time of EUS) to 12 years.


Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer.

Lawson RD, Hunt GC, Giap AQ, Krinsky ML, Slezak J, Tang RS, Gonzalez I, Kwong WT, Fehmi SA, Savides TJ - Ann Gastroenterol (2015 Oct-Dec)

Patient screening, exclusion, and group assignmentBD-IPMN, branch duct-intraductal papillary mucinous neoplasm; EUS, endoscopic ultrasound; HRG, highest-risk group; IPMN, intraductal papillary mucinous neoplasm; LRG, lowest-risk group
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585397&req=5

Figure 1: Patient screening, exclusion, and group assignmentBD-IPMN, branch duct-intraductal papillary mucinous neoplasm; EUS, endoscopic ultrasound; HRG, highest-risk group; IPMN, intraductal papillary mucinous neoplasm; LRG, lowest-risk group
Mentions: A total of 894 patients underwent EUS evaluation of one or more pancreatic cysts identified on CT or MRI during the study period (Fig. 1). Of this number 233 patients were excluded for the following suspected diagnoses: 16 MD-IMPN; 29 MCN; 52 SCN; 40 chronic pancreatitis; 35 pseudocyst; 3 history of pancreatic cancer; 1 with von Hippel-Lindau. 57 were excluded for inadequate follow up. Following these exclusions 661 patients comprised the cohort including 218 patients from Kaiser Permanente, Anaheim Medical Center, California; 148 patients from Kaiser Permanente, San Diego Medical Center/Kaiser Foundation Hospital, California; 235 patients from the University of California, San Diego, California; and 60 patients from the Veterans Administration Medical Center, La Jolla, California. Females comprised 55.8%; average age was 67.4 years; and pancreatic cysts were predominantly asymptomatic (67%). Compared to the LRG, patients in the HRG were more often male (53.6% vs 38.4%, P=0.0001), older (68.7 years vs. 66.5 years, P=0.0051), followed for a shorter period of time (3.7 years vs. 4.1 years, P= 0.0013), more often symptomatic (46.4% vs. 24.8%, P<0.0001) and more likely to undergo surgical resection (14.4% vs. 3.5%, P=0.0001). The cohort was followed for an average of 3.8 years, ranging between 3 days (patients diagnosed with pancreatic cancer at time of EUS) to 12 years.

Bottom Line: Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up.Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Naval Medical Center, San Diego, California (Robert D. Lawson).

ABSTRACT

Background: The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").

Methods: Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).

Results: After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).

Conclusions: This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.

No MeSH data available.


Related in: MedlinePlus