Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved]
Background: Pancreatic cystic lesions (PCL) are being detected with increasing frequency. Current methods of stratifying risk of malignant transformation are imperfect. This study aimed to determine the frequency of pancreatic malignancy in patients with PCL and define clinical and radiological feat...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2020-01-01
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| Series: | AMRC Open Research |
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| Online Access: | https://healthopenresearch.org/articles/1-4/v2 |
| _version_ | 1797724972761743360 |
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| author | Hannah R. Dadds Margaret G. Keane Tu Vinh Luong Ghassan El Sayed Guiseppe K. Fusai Brian R. Davidson Stephen P. Pereira Douglas Thorburn |
| author_facet | Hannah R. Dadds Margaret G. Keane Tu Vinh Luong Ghassan El Sayed Guiseppe K. Fusai Brian R. Davidson Stephen P. Pereira Douglas Thorburn |
| author_sort | Hannah R. Dadds |
| collection | DOAJ |
| description | Background: Pancreatic cystic lesions (PCL) are being detected with increasing frequency. Current methods of stratifying risk of malignant transformation are imperfect. This study aimed to determine the frequency of pancreatic malignancy in patients with PCL and define clinical and radiological features that predict malignant transformation in patients managed by surgery and/or surveillance. Methods: A retrospective cohort of adults who were evaluated in a tertiary hepatopancreaticobiliary centre between January 2000 - December 2013 with a confirmed PCL and followed up for at least 5 years. All cystic lesions were discussed at a weekly multidisciplinary meeting. Results: Of the 1,090 patients diagnosed with a PCL, 768 patients were included in the study: 141 patients were referred for immediate pancreatic resection, 570 entered surveillance while 57 had a malignant PCL which was unresectable at diagnosis (n=47) or were unfit for surgery (n=10). In those who were resected following presentation, malignancy was present in 38%. During follow-up 2% of those entering a surveillance programme underwent malignant transformation. Clinical and radiological features associated with a high-risk PCL included older age, symptoms, associated solid component or dilated main pancreatic duct. In intraductal papillary mucinous neoplasms, larger size was not a feature of malignant transformation (benign vs. malignant 30mm vs. 23mm; P= 0.012). Conclusion: The sensitivity of standard diagnostic tests leading to immediate surgery for high-risk PCL (malignant or mucinous) was 92% but with a specificity of just 5%. Surveillance of PCL without high-risk features within a multidisciplinary meeting was associated with a low incidence of cancer development, supporting the use of worrisome clinical and radiological features in the initial stratification of PCL. |
| first_indexed | 2024-03-12T10:24:31Z |
| format | Article |
| id | doaj.art-521781665e2f4fa386207397d0cf5765 |
| institution | Directory Open Access Journal |
| issn | 2517-6900 |
| language | English |
| last_indexed | 2024-03-12T10:24:31Z |
| publishDate | 2020-01-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | AMRC Open Research |
| spelling | doaj.art-521781665e2f4fa386207397d0cf57652023-09-02T09:49:58ZengF1000 Research LtdAMRC Open Research2517-69002020-01-01113960Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved]Hannah R. Dadds0Margaret G. Keane1https://orcid.org/0000-0001-7477-4541Tu Vinh Luong2Ghassan El Sayed3Guiseppe K. Fusai4Brian R. Davidson5Stephen P. Pereira6https://orcid.org/0000-0003-0821-1809Douglas Thorburn7Institute for Liver and Digestive Health, University College London, London, NW3 2QG, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKDepartment of Gastroenterology, University College London Hospitals NHS Trust, London, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKInstitute for Liver and Digestive Health, University College London, London, NW3 2QG, UKBackground: Pancreatic cystic lesions (PCL) are being detected with increasing frequency. Current methods of stratifying risk of malignant transformation are imperfect. This study aimed to determine the frequency of pancreatic malignancy in patients with PCL and define clinical and radiological features that predict malignant transformation in patients managed by surgery and/or surveillance. Methods: A retrospective cohort of adults who were evaluated in a tertiary hepatopancreaticobiliary centre between January 2000 - December 2013 with a confirmed PCL and followed up for at least 5 years. All cystic lesions were discussed at a weekly multidisciplinary meeting. Results: Of the 1,090 patients diagnosed with a PCL, 768 patients were included in the study: 141 patients were referred for immediate pancreatic resection, 570 entered surveillance while 57 had a malignant PCL which was unresectable at diagnosis (n=47) or were unfit for surgery (n=10). In those who were resected following presentation, malignancy was present in 38%. During follow-up 2% of those entering a surveillance programme underwent malignant transformation. Clinical and radiological features associated with a high-risk PCL included older age, symptoms, associated solid component or dilated main pancreatic duct. In intraductal papillary mucinous neoplasms, larger size was not a feature of malignant transformation (benign vs. malignant 30mm vs. 23mm; P= 0.012). Conclusion: The sensitivity of standard diagnostic tests leading to immediate surgery for high-risk PCL (malignant or mucinous) was 92% but with a specificity of just 5%. Surveillance of PCL without high-risk features within a multidisciplinary meeting was associated with a low incidence of cancer development, supporting the use of worrisome clinical and radiological features in the initial stratification of PCL.https://healthopenresearch.org/articles/1-4/v2Pancreatic cystic lesion IPMN MCN SCN SPN Pancreatic cancereng |
| spellingShingle | Hannah R. Dadds Margaret G. Keane Tu Vinh Luong Ghassan El Sayed Guiseppe K. Fusai Brian R. Davidson Stephen P. Pereira Douglas Thorburn Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] AMRC Open Research Pancreatic cystic lesion IPMN MCN SCN SPN Pancreatic cancer eng |
| title | Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] |
| title_full | Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] |
| title_fullStr | Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] |
| title_full_unstemmed | Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] |
| title_short | Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review [version 2; peer review: 2 approved] |
| title_sort | clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas a retrospective case note review version 2 peer review 2 approved |
| topic | Pancreatic cystic lesion IPMN MCN SCN SPN Pancreatic cancer eng |
| url | https://healthopenresearch.org/articles/1-4/v2 |
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