| Autor: |
Ge PS; Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States., Muthusamy VR; Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States., Gaddam S; Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States., Jaiyeola DM; Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States., Kim S; Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States., Sedarat A; Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States., Donahue TR; University of California Los Angeles David Geffen School of Medicine - Department of Surgery, Los Angeles, California, United States., Hosford L; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States., Wilson RH; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States., Grande DP; Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States., Keswani RN; Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States., Kushnir VM; Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States., Mullady D; Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States., Edmundowicz SA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States., Early DS; Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States., Komanduri S; Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States., Wani S; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States., Watson RR; Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States. |
| Abstrakt: |
Background and study aims The American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs. Patients and methods A retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 - 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated. Results Three hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 - 92.1), 69.1 % specificity (95 % CI 62.9 - 74.8), 37.2 % positive predictive value (95 % CI 28.6 - 46.4), 95.0 % negative predictive value (95 % CI 90.7 - 97.7), and 71.7 % accuracy (95 % CI 67.4 - 74.6). Conclusions The 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines. Meeting presentations: Presented in part at Digestive Diseases Week 2016. |
