American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data

2016 ◽  
Vol 83 (6) ◽  
pp. 1107-1117.e2 ◽  
Author(s):  
Aatur D. Singhi ◽  
Herbert J. Zeh ◽  
Randall E. Brand ◽  
Marina N. Nikiforova ◽  
Jennifer S. Chennat ◽  
...  
Keyword(s):  
Molecular Data ◽  
Pancreatic Cysts ◽  
American Gastroenterological Association ◽  
Advanced Neoplasia ◽  
Clinicopathologic Study

The clinical utility of the 2017 Fukuoka Guidelines and 2015 American Gastroenterological Association Guidelines for the management of intraductal papillary mucinous neoplasms.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 640-640
Author(s):  
Gandhi Lanke ◽  
Donald Campbell ◽  
Emmanuel Coronel ◽  
Manoop S. Bhutani ◽  
Brian Weston ◽  
...  
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Clinical Utility ◽  
Operating Characteristic ◽  
Pancreatic Head ◽  
Pancreatic Cysts ◽  
American Gastroenterological Association ◽  
Mucinous Neoplasms ◽  
Worrisome Feature

640 Background: Mucinous cystadenocarcinoma are malignant and mucinous pancreatic cysts (PC) have malignant potential. The management of PC remains controversial despite consensus guidelines. This study aims to evaluate the clinical utility of the 2017 Fukuoka Guidelines (FG) and 2015 American Gastroenterological Association Guidelines (AGA-G) for the management of PC. Methods: 212 patients who underwent EUS for PC between 2010 and 2017 were identified. The FG and AGA-G were used to define worrisome and high-risk cyst features. Receiver Operating Characteristic (ROC) curve was used to define sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Results: 141 of 212 patients had IPMNs.EUS-FNA was performed in 76.5% with no reported complications. Median follow-up was 4.2 years. The majority of the IPMNs were in the pancreatic head (44.7%) or body (39.7%) while only 15.6 % were in the tail. Using the FG, 46.1% had at least one worrisome feature (FG-W) and 7.1% had at least one high risk feature (FG-HR). Using the AGA-G, 28.4% had at least one HR feature (AGA-HR1) and 1.4% patients had two or more risk factors (AGA-HR2). A change in cyst character (increase of > 5 mm in 2 years, development of a solid component, or new pancreatic duct dilation) was noted in 43.2% patients. The median time to cyst change was 21 months. For prediction of cyst changes, the FG-W had a SN of 45.8%, SP of 55.4%, PPV 45%, and NPV 56%. FG-HR had a SN of 14.3%, SP of 53.2%, PPV 1.7%, and NPV 91.8%. AGA-HR1 had a SN of 35.3%, SP of 51.5%, PPV 20%, and NPV 69.9%. AGA-HR2 had a SN of 0%, SP of 54.2%, PPV 0%, and NPV 97.3%. No difference was seen in cyst change or development of high risk or worrisome features with CEA > 192 vs. < 192 (p = 0.99). During follow up, 14 patients died, but only one patient died of pancreatic cancer. Conclusions: FG and AGA-G are difficult to validate because malignant cyst transformation is rare. There was no correlation between any cyst characteristics on EUS and cyst changes. FG-W had the best performance in predicting changes. Surgical candidates should be carefully selected, as these guidelines have a limited clinical utility.

scholarly journals Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts

2017 ◽  
Vol 05 (02) ◽  
pp. E116-E122 ◽  
Author(s):  
Alexander Lee ◽  
Vivek Kadiyala ◽  
Linda Lee
Keyword(s):  
Predictive Value ◽  
International Association ◽  
Pancreatic Cysts ◽  
Lower Sensitivity ◽  
Resonance Imaging ◽  
American Gastroenterological Association ◽  
Risk Patients ◽  
Malignant Lesions ◽  
Selection For ◽  
Magnetic Resonance Imaging Mri

Abstract Objectives Management of asymptomatic pancreatic cysts is challenging. Guidelines by the American Gastroenterological Association (AGA) and International Association of Pancreatology (Fukuoka) seek to identify high-risk patients. We assessed performance of these guidelines in selecting patients for endoscopic ultrasound (EUS) and/or surgery. Methods PART I – We retrospectively studied 143 asymptomatic cysts with magnetic resonance imaging (MRI) followed by EUS. Appropriate selection for EUS was defined as: malignant cytology or surgical pathology, or development of concerning features on MRI as defined by the guidelines. PART II – We retrospectively studied 152 resected cysts to assess the performance of guidelines in selecting cysts for surgery using malignant histology as the outcome. Results PART I – Of 143 EUS, 43 (30.1 %) were male with median age 65.0 years (interquartile range [IQR] 58.0 – 73.0). AGA guideline demonstrated lower sensitivity (17.6 % versus 35.3 %, P = 0.03), higher specificity (94.5 % versus 66.1 %, p < 0.001), and higher accuracy (76.2 % versus 58.7 %, P = 0.002) than Fukuoka. There was no difference in positive predictive value (50.0 % versus 24.5 %, P = 0.15) and negative predictive value (78.6 % versus 76.6 %, p=0.75). PART II – Of 152 resected cysts, 45 (29.8 %) were male with median age 59.0 years (IQR 47.3 – 66.7). There was no difference in performance characteristics of the guidelines in selecting cysts for surgery. AGA and Fukuoka guidelines missed 25.0 % and 18.8 % of malignant cysts, respectively (P = 1.00). Conclusions For referral to EUS, the AGA guideline was highly specific compared to Fukuoka; both suffered from poor sensitivity, although the Fukuoka guideline was relatively more sensitive than AGA. For referral to surgery, both guidelines have modest sensitivity and specificity and miss a similar percentage of malignant lesions.

scholarly journals Novel Methylated DNA Markers Discriminate Advanced Neoplasia in Pancreatic Cysts

2019 ◽  
Vol 114 (9) ◽  
pp. 1539-1549 ◽  
Author(s):  
Shounak Majumder ◽  
William R. Taylor ◽  
Tracy C. Yab ◽  
Calise K. Berger ◽  
Brian A. Dukek ◽  
...  
Keyword(s):  
Dna Markers ◽  
Pancreatic Cysts ◽  
Methylated Dna ◽  
Advanced Neoplasia

American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

2015 ◽  
Vol 148 (4) ◽  
pp. 819-822 ◽  
Author(s):  
Santhi Swaroop Vege ◽  
Barry Ziring ◽  
Rajeev Jain ◽  
Paul Moayyedi ◽  
Megan A. Adams ◽  
...  
Keyword(s):  
Pancreatic Cysts ◽  
American Gastroenterological Association ◽  
Diagnosis And Management

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

2018 ◽  
Vol 09 (01) ◽  
pp. 001-005
Author(s):  
Krishnan Kumar ◽  
Omer Anam ◽  
Raza Ali ◽  
Miller A Ross ◽  
Mody R Dina ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Retrospective Cohort ◽  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Study Cohort ◽  
American Gastroenterological Association ◽  
Cross Sectional ◽  
Occult Malignancy ◽  
Cross Sectional Imaging ◽  
The Mean

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.

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