Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements

Because pancreatic cancer has a dismal prognosis, a strategy for early diagnosis is required. This study aimed to identify predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). Patients with slight main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm) were enrolled in a prospective surveillance study with special pancreatic US in a Japanese cancer referral center. A total of 498 patients undergoing surveillance for ≥3 years were included. During the median follow-up of 5.9 years, neoplastic progression developed in 11 patients (2.2%), including 9 patients who underwent pancreatectomy. Eight patients (72.7%) were diagnosed with stage 0/I disease, with an overall survival duration of 8.8 years. Findings of both MPD dilatation and pancreatic cysts at initial surveillance, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were identified as independent risk factors for neoplastic progression. In summary, surveillance with special pancreatic US for high-risk individuals contributed to earlier detection of neoplastic progression, leading to a favorable prognosis. During surveillance, attention should be paid to MPD growth as well as to cyst growth.

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Sa1351 – Elevated Hemoglobin A1C is Associated with Pancreatic Cysts in a High-Risk Pancreatic Surveillance Program

Gastroenterology ◽

10.1016/s0016-5085(19)37638-3 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-323

Author(s):

Ariel Bar-Mashiah ◽

Anne Aronson ◽

Monica Naparst ◽

Christopher J. DiMaio ◽

Aimee L. Lucas

Keyword(s):

High Risk ◽

Hemoglobin A1c ◽

Pancreatic Cysts ◽

Surveillance Program

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Long-term follow-up of neoplastic pancreatic cysts without high-risk stigmata: how often do we change treatment strategy because of malignant transformation?

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2016.1179338 ◽

2016 ◽

Vol 51 (9) ◽

pp. 1138-1143 ◽

Cited By ~ 3

Author(s):

Selma J. Lekkerkerker ◽

Marc G. Besselink ◽

Olivier R. Busch ◽

Frederike Dijk ◽

Marc R. Engelbrecht ◽

...

Keyword(s):

High Risk ◽

Malignant Transformation ◽

Treatment Strategy ◽

Pancreatic Cysts ◽

Long Term Follow Up

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Characteristics and Clinical Outcomes of Individuals at High Risk for Pancreatic Cancer: A Descriptive Analysis from a Comprehensive Cancer Center

Gastrointestinal Disorders ◽

10.3390/gidisord1010008 ◽

2018 ◽

Vol 1 (1) ◽

pp. 106-119

Author(s):

Griffin McNamara ◽

Karla Ali ◽

Shraddha Vyas ◽

Tri Huynh ◽

Monica Nyland ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Clinical Outcomes ◽

Genetic Risk ◽

Incidental Findings ◽

The United States ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Pancreatic Cysts ◽

Sporadic Cases

Pancreatic cancer (PC), a leading cause of cancer-related deaths in the United States, is typically diagnosed at an advanced stage. To improve survival, there is an unmet need to detect pre-malignant lesions and early invasive disease. Prime populations to study for early detection efforts include cohorts of high risk individuals (HRI): those with increased risk to develop pre-malignant pancreatic cysts and PC because of a familial or hereditary predisposition to the disease and those in the general population of sporadic cases who are incidentally found to harbor a pre-malignant pancreatic cyst. The objective of this study was to describe the characteristics and clinical outcomes of cohorts of HRI identified at Moffitt Cancer Center. We set out to determine the uptake of screening, the prevalence and characteristics of solid and cystic pancreatic lesions detected via screening or as incidental findings, and the age at which lesions were detected. Of a total of 329 HRI, roughly one-third were found to have pancreatic lesions, most of which constituted pre-malignant cysts known as intraductal papillary mucinous neoplasms. Individuals with the highest genetic risk for PC were found to have smaller cysts at a much earlier age than sporadic cases with incidental findings; however, many individuals at high genetic risk did not have abdominal imaging reports on file. We also identified a subset of HRI at moderate genetic risk for PC that were found to have cystic and solid pancreatic lesions as part of a diagnostic work-up rather than a screening protocol. These findings suggest the pancreatic research community should consider expanding criteria for who should be offered screening. We also emphasize the importance of continuity of care between cancer genetics and gastrointestinal oncology clinics so that HRI are made aware of the opportunities related to genetic counseling, genetic testing, and screening.

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Cancer of the Pancreas: Clinical Outcome in 76 Cases

Tumori Journal ◽

10.1177/030089168607200611 ◽

1986 ◽

Vol 72 (6) ◽

pp. 601-607 ◽

Cited By ~ 3

Author(s):

Vittorio Pugliese ◽

Sebastiano Saccomanno ◽

Luigina Bonelli ◽

Daniela Barone ◽

Massimo Conio ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Clinical Outcome ◽

Clinical Presentation ◽

High Sensitivity ◽

Radical Resection ◽

Final Diagnosis ◽

Diagnostic Techniques ◽

Tissue Diagnosis ◽

Cancer Of The Pancreas

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

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A second endoscopic ultrasound with fine‐needle aspiration for cytology identifies high‐risk pancreatic cysts overlooked by current guidelines

Diagnostic Cytopathology ◽

10.1002/dc.24607 ◽

2020 ◽

Vol 49 (1) ◽

pp. 109-118

Author(s):

Sandra Faias ◽

Luisa Pereira ◽

Ricardo Fonseca ◽

Paula Chaves ◽

António Dias Pereira ◽

...

Keyword(s):

High Risk ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Pancreatic Cysts ◽

Fine Needle ◽

Current Guidelines

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.640 ◽

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.

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