Epidemiology, clinical features and diagnostic work-up of cystic neoplasms of the pancreas: Interim analysis of the prospective PANCY survey

Published on May 1, 2020in Digestive and Liver Disease3.57
· DOI :10.1016/J.DLD.2020.02.003
Raffaele Pezzilli54
Estimated H-index: 54
,
Elisabetta Buscarini42
Estimated H-index: 42
+ 42 AuthorsMassimo Falconi105
Estimated H-index: 105
Sources
Abstract
Abstract Introduction A prospective survey to evaluate the diagnostic workup of cystic pancreatic neoplasms (CPNs) according to the Italian guidelines. Methods An online data sheet was built. Results Fifteen of the 1385 patients (1.1%) had non cystic neoplastic lesions. Forty percent (518/1295) had at least one 1st degree relative affected by a solid tumor of the digestive and extra-digestive organs. Symptoms/signs associated with the cystic lesion were present in 24.5% of the patients. The cysts were localized in the head of the pancreas in 38.5% of patients. Of the 2370 examinations (1.7 examinations per patient) which were carried out for the diagnosis, magnetic resonance imaging was performed as a single test in 48.4% of patients and in combination with endoscopic ultrasound in 27% of the cases. Of the 1370 patients having CPNs, 89.9% had an intraductal papillary mucinous neoplasm (IPMN) (70.1% a branch duct IPMN, 6.2% a mixed type IPMN and 4.6% a main duct IPMN), 12.7% had a serous cystadenoma, 2.8% a mucinous cystadenoma, 1.5% a non-functioning cystic neuroendocrine neoplasm, 0.7% a solid-pseudopapillary cystic neoplasm, 0.3% a cystic adenocarcinoma, and 1.2% an undetermined cystic neoplasm. Seventy-eight (5.7%) patients were operated upon after the initial work-up. Conclusions This prospective study offers a reliable real-life picture of the diagnostic work-up CPN.
📖 Papers frequently viewed together
1 Citations
References22
Newest
#1Simeon Springer (Johns Hopkins University)H-Index: 18
#2David L. Masica (Johns Hopkins University)H-Index: 25
Last. Anne Marie LennonH-Index: 43
view all 60 authors...
Pancreatic cysts are common and often pose a management dilemma, because some cysts are precancerous, whereas others have little risk of developing into invasive cancers. We used supervised machine learning techniques to develop a comprehensive test, CompCyst, to guide the management of patients with pancreatic cysts. The test is based on selected clinical features, imaging characteristics, and cyst fluid genetic and biochemical markers. Using data from 436 patients with pancreatic cysts, we tra...
35 CitationsSource
#1Matthew Kulzer (University of Pittsburgh)H-Index: 3
#2Aatur D. Singhi (University of Pittsburgh)H-Index: 41
Last. Anil K. Dasyam (University of Pittsburgh)H-Index: 16
view all 9 authors...
Cystic neoplasms in the pancreas are encountered frequently on imaging, often detected incidentally during evaluation for other conditions. They can have a variety of clinical and imaging presentations, and similarly, wide-ranging prognostic and treatment implications. In the majority, imaging helps in diagnosis of pancreatic cystic neoplasms (PCNs) and guides management decisions. But, a significant minority of the PCNs remain indeterminate. There have been multiple recent advances in biomarker...
8 CitationsSource
#1Giulia Zerboni (Sapienza University of Rome)H-Index: 7
#2Marianna Signoretti (Sapienza University of Rome)H-Index: 13
Last. Gabriele CapursoH-Index: 56
view all 6 authors...
Abstract Background & aims Pancreatic cystic lesions (PCLs) are frequent incidental findings. As most PCLs require costly diagnostic evaluation and active surveillance, it is important to clarify their prevalence in asymptomatic individuals. We therefore aimed at performing a systematic review and meta-analysis to determine it. Methods: a systematic search was conducted and studies meeting inclusion criteria were included. The prevalence of PCLs was pooled across studies. A random effect model w...
37 CitationsSource
#1Gianpaolo BalzanoH-Index: 44
#2Giovanni CaprettiH-Index: 16
Last. Raffaele PezzilliH-Index: 54
view all 6 authors...
Background According to current guidelines, pancreatic cancer patients should be strictly selected for surgery, either palliative or resective.
26 CitationsSource
#1B. JaisH-Index: 1
#2Vinciane ReboursH-Index: 38
Last. Philippe LévyH-Index: 57
view all 88 authors...
Objectives Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. Design Retrospective multinational study including SCN diagnosed between 1990 and 2014. Results 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16–99). Patients presented with non-specific abdominal pain (27%), pa...
146 CitationsSource
#1Alexis M. CahalaneH-Index: 5
#2Yvonne PurcellH-Index: 6
Last. Dermot E. MaloneH-Index: 23
view all 7 authors...
Background and aim Cystic pancreatic neoplasms (CPNs) are an increasingly diagnosed entity. Their heterogeneity poses complex diagnostic and management challenges. Despite frequently encountering these entities, particularly in the context of the increased imaging of patients in modern medicine, doctors have to rely on incomplete and ambiguous published literature. The aim of this project was to review the guidelines relating to CPNs using evidence-based practice (EBP) methods.
9 CitationsSource
Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical man...
79 CitationsSource
#1Massimo Falconi (Marche Polytechnic University)H-Index: 105
#2Stefano Crippa (Marche Polytechnic University)H-Index: 60
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
view all 11 authors...
Background: Though cystic pancreatic neoplasms (CPNs) are being increasingly detected, their evaluation and management are still debated and have lead to publication of multiple guidelines for diagnostic work-up, indications for resection, and non-operative management with follow-up strategies of CPNs. Aims: To analyze available guidelines in order to evaluate their overall quality and clinical applicability, indications for surgical resection and its extent, modalities and timing of follow-up w...
17 CitationsSource
#1Nicola ZaniniH-Index: 10
#2Marco GiordanoH-Index: 2
Last. Giovanni LandolfoH-Index: 5
view all 14 authors...
Abstract Background There has been a dramatic increase in the number of pancreatic cystic lesions observed in the past two decades but data regarding the prevalence of cysts in the general population are lacking. Methods All the individuals who undergo CT at the San Marino State Hospital are residents of the Republic of San Marino; their demographic distribution is available and precise. CT scans carried out over 1 year at the State Hospital were reviewed for asymptomatic pancreatic cysts. Resul...
23 CitationsSource
The majority of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are branch duct (BD) IPMNs, and these neoplasms are being diagnosed with increasing frequency; no data are also available on the well-being (quality of life [QoL]) of these patients. We aimed to evaluate the 2-year follow-up results in consecutive patients with BD-IPMNs to assess symptoms at presentation and their morphological progression; the physical and psychological statuses of these patients were also evaluate...
14 CitationsSource
Cited By1
Newest
#1Vincenzo NascaH-Index: 1
#2Marta Chiaravalli (UCSC: Catholic University of the Sacred Heart)H-Index: 1
Last. Carmine CarboneH-Index: 20
view all 8 authors...
Pancreatic ductal adenocarcinoma is one of the most lethal human cancers. Its precursor lesions include pancreatic intra-epithelial neoplasia, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm (IPMN). IPMNs usually present as an incidental finding at imaging in 2.6% of the population and, according to the degree of dysplasia, they are classified as low- or high-grade lesions. Since the risk of malignant transformation is not accurately predictable, the management of these les...
1 CitationsSource