TY - JOUR
T1 - Guidelines on management of pancreatic cysts detected in high-risk individuals
T2 - An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements
AU - Dbouk, Mohamad
AU - Brewer Gutierrez, Olaya I.
AU - Lennon, Anne Marie
AU - Chuidian, Miguel
AU - Shin, Eun Ji
AU - Kamel, Ihab R.
AU - Fishman, Elliot K.
AU - He, Jin
AU - Burkhart, Richard A.
AU - Wolfgang, Christopher L.
AU - Hruban, Ralph H.
AU - Goggins, Michael G.
AU - Canto, Marcia Irene
N1 - Funding Information:
Grant Support : This work was supported by NIH grants ( U01210170 , CA62924 , and R01CA176828 ), Susan Wojcicki and Dennis Troper, the Pancreatic Cancer Action Network , the Rolfe Pancreatic Cancer Foundation , and by a Stand Up To Cancer- Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant (Grant Number: SU2C-AACR-DT25-17 ). Stand Up To Cancer is a program of the Entertainment Industry Foundation. SU2C research grants are administered by the American Association for Cancer Research , the scientific partner of SU2C . MG is the Sol Goldman Professor of Pancreatic Cancer Research.
Funding Information:
Other approaches that rely on blood-based biomarkers for the detecting of HGD or cancer in IPMNs have been proposed to avoid invasive procedures (EUS, ERCP) that are needed to acquire cyst fluid. Unfortunately, we still lack strong evidence that supports the clinical use of these biomarkers, such as CA19-9, CEA, or miRNAs [36].Grant Support: This work was supported by NIH grants (U01210170, CA62924, and R01CA176828), Susan Wojcicki and Dennis Troper, the Pancreatic Cancer Action Network, the Rolfe Pancreatic Cancer Foundation, and by a Stand Up To Cancer-Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant (Grant Number: SU2C-AACR-DT25-17). Stand Up To Cancer is a program of the Entertainment Industry Foundation. SU2C research grants are administered by the American Association for Cancer Research, the scientific partner of SU2C. MG is the Sol Goldman Professor of Pancreatic Cancer Research.
Publisher Copyright:
© 2021
PY - 2021/4
Y1 - 2021/4
N2 - Background: Objectives: Pancreatic cysts are frequently detected in high-risk individuals (HRI) undergoing surveillance for pancreatic cancer. The International Cancer of the Pancreas Screening (CAPS) Consortium developed consensus recommendations for surgical resection of pancreatic cysts in HRI that are similar to the Fukuoka guidelines used for the management of sporadic cysts. We compared the performance characteristics of CAPS criteria for pancreatic cyst management in HRI with the Fukuoka guidelines originally designed for the management of cysts in non-HRI. Methods: Using prospectively collected data from CAPS studies, we determined for each patient with resected screen-detected cyst(s) whether Fukuoka guidelines or CAPS consensus statements would have recommended surgery. We compared sensitivity, specificity, PPV, NPV, and Receiver Operator Characteristics (ROC) curves of these guidelines at predicting the presence of high-grade dysplasia or invasive cancer in pancreatic cysts. Results: 356/732 HRI had ≥ one pancreatic cyst detected; 24 had surgery for concerning cystic lesions. The sensitivity, specificity, PPV, and NPV for the Fukuoka criteria were 40%, 85%, 40%, and 85%, while those of the CAPS criteria were 60%, 85%, 50%, 89%, respectively. ROC curve analyses showed no significant difference between the Fukuoka and CAPS criteria. Conclusions: In HRI, the CAPS and Fukuoka criteria are moderately specific, but not sufficiently sensitive for detecting advanced neoplasia in cystic lesions. New approaches are needed to guide the surgical management of cystic lesions in HRI.
AB - Background: Objectives: Pancreatic cysts are frequently detected in high-risk individuals (HRI) undergoing surveillance for pancreatic cancer. The International Cancer of the Pancreas Screening (CAPS) Consortium developed consensus recommendations for surgical resection of pancreatic cysts in HRI that are similar to the Fukuoka guidelines used for the management of sporadic cysts. We compared the performance characteristics of CAPS criteria for pancreatic cyst management in HRI with the Fukuoka guidelines originally designed for the management of cysts in non-HRI. Methods: Using prospectively collected data from CAPS studies, we determined for each patient with resected screen-detected cyst(s) whether Fukuoka guidelines or CAPS consensus statements would have recommended surgery. We compared sensitivity, specificity, PPV, NPV, and Receiver Operator Characteristics (ROC) curves of these guidelines at predicting the presence of high-grade dysplasia or invasive cancer in pancreatic cysts. Results: 356/732 HRI had ≥ one pancreatic cyst detected; 24 had surgery for concerning cystic lesions. The sensitivity, specificity, PPV, and NPV for the Fukuoka criteria were 40%, 85%, 40%, and 85%, while those of the CAPS criteria were 60%, 85%, 50%, 89%, respectively. ROC curve analyses showed no significant difference between the Fukuoka and CAPS criteria. Conclusions: In HRI, the CAPS and Fukuoka criteria are moderately specific, but not sufficiently sensitive for detecting advanced neoplasia in cystic lesions. New approaches are needed to guide the surgical management of cystic lesions in HRI.
KW - High-risk individuals
KW - Intraductal papillary mucinous neoplasm (IPMN)
KW - Pancreatic cancer
KW - Pancreatic cyst
KW - Pancreatic intraepithelial neoplasia (PanIN)
KW - Surveillance
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U2 - 10.1016/j.pan.2021.01.017
DO - 10.1016/j.pan.2021.01.017
M3 - Article
C2 - 33593706
AN - SCOPUS:85101050585
SN - 1424-3903
VL - 21
SP - 613
EP - 621
JO - Pancreatology
JF - Pancreatology
IS - 3
ER -