Prediction of malignancy in cystic neoplasms of the pancreas: A population-based cohort study

Bechien U. Wu, Kartik Sampath, Christopher E. Berberian, Karl K. Kwok, Brian S. Lim, Kevin T. Kao, Andrew Q. Giap, Anne E. Kosco, Yasir M. Akmal, Andrew L. Difronzo, Wei Yu, Eunis W. Ngor

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Abstract

OBJECTIVES:Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN.METHODS:We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features.RESULTS:We identified 1,815 patients with confirmed PCN. A total of 53 (2.9%) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4% per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95% confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1%), intermediate (1-5%), and high (9-14%) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing).CONCLUSIONS:Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.

Original languageEnglish (US)
Pages (from-to)121-129
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume109
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

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Pancreatic Neoplasms
Cohort Studies
Population
Neoplasms
Incidence
Cysts
Pancreatic Ducts
Chronic Pancreatitis
Dilatation
Retrospective Studies
Growth

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wu, B. U., Sampath, K., Berberian, C. E., Kwok, K. K., Lim, B. S., Kao, K. T., ... Ngor, E. W. (2014). Prediction of malignancy in cystic neoplasms of the pancreas: A population-based cohort study. American Journal of Gastroenterology, 109(1), 121-129. https://doi.org/10.1038/ajg.2013.334

Prediction of malignancy in cystic neoplasms of the pancreas : A population-based cohort study. / Wu, Bechien U.; Sampath, Kartik; Berberian, Christopher E.; Kwok, Karl K.; Lim, Brian S.; Kao, Kevin T.; Giap, Andrew Q.; Kosco, Anne E.; Akmal, Yasir M.; Difronzo, Andrew L.; Yu, Wei; Ngor, Eunis W.

In: American Journal of Gastroenterology, Vol. 109, No. 1, 01.2014, p. 121-129.

Research output: Contribution to journalArticle

Wu, BU, Sampath, K, Berberian, CE, Kwok, KK, Lim, BS, Kao, KT, Giap, AQ, Kosco, AE, Akmal, YM, Difronzo, AL, Yu, W & Ngor, EW 2014, 'Prediction of malignancy in cystic neoplasms of the pancreas: A population-based cohort study', American Journal of Gastroenterology, vol. 109, no. 1, pp. 121-129. https://doi.org/10.1038/ajg.2013.334
Wu, Bechien U. ; Sampath, Kartik ; Berberian, Christopher E. ; Kwok, Karl K. ; Lim, Brian S. ; Kao, Kevin T. ; Giap, Andrew Q. ; Kosco, Anne E. ; Akmal, Yasir M. ; Difronzo, Andrew L. ; Yu, Wei ; Ngor, Eunis W. / Prediction of malignancy in cystic neoplasms of the pancreas : A population-based cohort study. In: American Journal of Gastroenterology. 2014 ; Vol. 109, No. 1. pp. 121-129.
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title = "Prediction of malignancy in cystic neoplasms of the pancreas: A population-based cohort study",
abstract = "OBJECTIVES:Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN.METHODS:We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features.RESULTS:We identified 1,815 patients with confirmed PCN. A total of 53 (2.9{\%}) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4{\%} per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95{\%} confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1{\%}), intermediate (1-5{\%}), and high (9-14{\%}) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing).CONCLUSIONS:Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.",
author = "Wu, {Bechien U.} and Kartik Sampath and Berberian, {Christopher E.} and Kwok, {Karl K.} and Lim, {Brian S.} and Kao, {Kevin T.} and Giap, {Andrew Q.} and Kosco, {Anne E.} and Akmal, {Yasir M.} and Difronzo, {Andrew L.} and Wei Yu and Ngor, {Eunis W.}",
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T1 - Prediction of malignancy in cystic neoplasms of the pancreas

T2 - A population-based cohort study

AU - Wu, Bechien U.

AU - Sampath, Kartik

AU - Berberian, Christopher E.

AU - Kwok, Karl K.

AU - Lim, Brian S.

AU - Kao, Kevin T.

AU - Giap, Andrew Q.

AU - Kosco, Anne E.

AU - Akmal, Yasir M.

AU - Difronzo, Andrew L.

AU - Yu, Wei

AU - Ngor, Eunis W.

PY - 2014/1

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N2 - OBJECTIVES:Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN.METHODS:We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features.RESULTS:We identified 1,815 patients with confirmed PCN. A total of 53 (2.9%) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4% per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95% confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1%), intermediate (1-5%), and high (9-14%) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing).CONCLUSIONS:Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.

AB - OBJECTIVES:Pancreatic cystic neoplasms (PCNs) are being detected with increased frequency. The aims of this study were to determine the incidence of malignancy and develop an imaging-based system for prediction of malignancy in PCN.METHODS:We conducted a retrospective cohort study of patients ≥18 years of age with confirmed PCN from January 2005 to December 2010 in a community-based integrated care setting in Southern California. Patients with history of acute or chronic pancreatitis were excluded. Malignancy diagnosed within 3 months of cyst diagnosis was considered as pre-existing. Subsequent incidence of malignancy during surveillance was calculated based on person-time at risk. Age- and gender-adjusted standardized incidence ratio (SIR) was calculated with the non-cyst reference population. Recursive partitioning was used to develop a risk prediction model based on cyst imaging features.RESULTS:We identified 1,815 patients with confirmed PCN. A total of 53 (2.9%) of patients were diagnosed with cyst-related malignancy during the study period. The surveillance cohort consisted of 1,735 patients with median follow-up of 23.4 months. Incidence of malignancy was 0.4% per year during surveillance. The overall age- and gender-adjusted SIR for pancreatic malignancy was 35.0 (95% confidence level 26.6, 46.0). Using recursive partitioning, we stratified patients into low (<1%), intermediate (1-5%), and high (9-14%) risk of harboring malignant PCN based on four cross-sectional imaging features: size, pancreatic duct dilatation, septations with calcification as well as growth. Area under the receiver operator characteristic curve for the prediction model was 0.822 (training) and 0.808 (testing).CONCLUSIONS:Risk of pancreatic malignancy was lower than previous reports from surgical series but was still significantly higher than the reference population. A risk stratification system based on established imaging criteria may help guide future management decisions for patients with PCN.

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