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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

Cumulative incidence of pancreatic cancer in the highest (upper red line) and lowest (lower black line) risk groups
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Figure 2: Cumulative incidence of pancreatic cancer in the highest (upper red line) and lowest (lower black line) risk groups

Mentions: There were 60 cases of pancreatic cancer (59 in HRG and 1 in LRG), 48 of which (80%) were diagnosed at the time of index EUS, immediate surgery or within first year of follow-up (Table 5). These prevalent cancers were diagnosed in 6.4% of the entire cohort, 19.2% of the HRG (42.8% of those with “high-risk stigmata” and 8.7% of those with “worrisome features”) and 0% of those in the LRG. Based upon Kaplan-Meier estimates the cumulative incidence of pancreatic cancer after 7 years of follow up was 28% in the HRG and 1.2% in the LRG (P<0.001) (Fig. 2).


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)

Cumulative incidence of pancreatic cancer in the highest (upper red line) and lowest (lower black line) risk groups
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Cumulative incidence of pancreatic cancer in the highest (upper red line) and lowest (lower black line) risk groups
Mentions: There were 60 cases of pancreatic cancer (59 in HRG and 1 in LRG), 48 of which (80%) were diagnosed at the time of index EUS, immediate surgery or within first year of follow-up (Table 5). These prevalent cancers were diagnosed in 6.4% of the entire cohort, 19.2% of the HRG (42.8% of those with “high-risk stigmata” and 8.7% of those with “worrisome features”) and 0% of those in the LRG. Based upon Kaplan-Meier estimates the cumulative incidence of pancreatic cancer after 7 years of follow up was 28% in the HRG and 1.2% in the LRG (P<0.001) (Fig. 2).

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