CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2018; 09(01): 001-005
DOI: 10.4103/jde.JDE_50_17
Original Article
Society of Gastrointestinal Endoscopy of India

Application of 2015 American Gastroenterological Association Guidelines On a Retrospective Cohort of Patients with Asymptomatic Pancreatic Cysts: Can We Truly Forego Endoscopic Ultrasound?

Krishnan Kumar
Department of Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
,
Omer Anam
Department of Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
,
Raza Ali
1   Division of Gastroenterology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
,
Miller A Ross
2   Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
,
Mody R Dina
2   Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
,
Krishnan Kumar
1   Division of Gastroenterology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX 77030, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
19 September 2019 (online)

Abstract

Objective: Asymptomatic pancreatic cysts are frequently diagnosed on cross-sectional imaging. Recently, the American Gastroenterological Association (AGA) has put forth guidelines regarding management of these cysts. To date, there is no strong data to indicate whether these guidelines will accurately identify malignancy and mitigate unnecessary endoscopic ultrasound (EUS) procedures. The aim of this investigation was to apply the 2015 AGA guidelines to a retrospective cohort of asymptomatic pancreatic cysts in a large regional referral center. Materials and Methods: This is a retrospective cohort study of patients with asymptomatic pancreatic cysts who underwent EUS with fine-needle aspiration (FNA) over a 3-year period. We applied current AGA guidelines to determine how many EUS procedures would be avoided, and further assessed whether the guidelines adequately identified cases of malignancy. Results: Forty-five patients were identified who underwent EUS FNA for an asymptomatic pancreatic cyst from 2011 to 2014. The mean age was 65 years, and the mean size cyst size was 2.8 cm. According to the 2015 AGA guidelines, EUS was indicated in 13 of the 45 patients and surveillance imaging in the remaining 32 patients. 3 of these 32 patients had atypical cytology on EUS FNA, and final histology showed adenocarcinoma in 2 patients and IMPN with high-grade dysplasia in 1 patient. Conclusion: Applying AGA guidelines in this study cohort would have prevented 32 out of 45 (71%) EUS procedures; however, 3 of these 32 patients had early occult malignancy. This data suggest that additional strategies are needed to identify those patients at high risk.

 
  • REFERENCES

  • 1 Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S. et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008; 191: 802-7
  • 2 Girometti R, Intini S, Brondani G, Como G, Londero F, Bresadola F. et al. Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: Prevalence and relation with clinical and imaging features. Abdom Imaging 2011; 36: 196-205
  • 3 Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010; 105: 2079-84
  • 4 Matsubara S, Tada M, Akahane M, Yagioka H, Kogure H, Sasaki T. et al. Incidental pancreatic cysts found by magnetic resonance imaging and their relationship with pancreatic cancer. Pancreas 2012; 41: 1241-6
  • 5 Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L. Pancreatic cysts: Depiction on single-shot fast spin-echo MR images. Radiology 2002; 223: 547-53
  • 6 Pyke CM, van Heerden JA, Colby TV, Sarr MG, Weaver AL. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 1992; 215: 132-9
  • 7 Sarr MG, Carpenter HA, Prabhakar LP, Orchard TF, Hughes S, van Heerden JA. et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: Can one reliably differentiate benign from malignant (or premalignant) neoplasms?. Ann Surg 2000; 231: 205-12
  • 8 Klöppel G. Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas. Hepatogastroenterology 1998; 45: 1981-5
  • 9 Warshaw AL, Compton CC, Lewandrowski K, Cardenosa G, Mueller PR. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990; 212: 432-43
  • 10 Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M. et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17-32
  • 11 Kaimakliotis P, Riff B, Pourmand K, Chandrasekhara V, Furth EE, Siegelman ES. et al. Sendai and fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol 2015; 13: 1808-15
  • 12 Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY. et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-97
  • 13 Vege SS, Ziring B, Jain R, Moayyedi P. Clinical Guidelines Committee, American Gastroenterology Association. et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819-22
  • 14 Lekkerkerker SJ, Besselink MG, Busch OR, Verheij J, Engelbrecht MR, Rauws EA. et al. Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome. Gastrointest Endosc 2017; 85: 1025-31
  • 15 Ma GK, Goldberg DS, Thiruvengadam N, Chandrasekhara V, Kochman ML, Ginsberg GG. et al. Comparing American Gastroenterological Association pancreatic cyst management guidelines with Fukuoka consensus guidelines as predictors of advanced neoplasia in patients with suspected pancreatic cystic neoplasms. J Am Coll Surg 2016; 223: 729-370