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Pandey P, Pandey A, Luo Y, Aliyari Ghasabeh M, Khoshpouri P, Ameli S, O’Broin-Lennon AM, Canto M, Hruban RH, Goggins MS, Wolfgang C, Kamel IR. Follow-up of Incidentally Detected Pancreatic Cystic Neoplasms: Do Baseline MRI and CT Features Predict Cyst Growth? Radiology 2019; 292:647-654. [PMID: 31310174 PMCID: PMC6716563 DOI: 10.1148/radiol.2019181686] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 05/12/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Background Incidental detection of pancreatic cystic neoplasm (PCN) has increased. Since a small percentage of PCNs possess malignant potential, management is challenging. The recently revised American College of Radiology (ACR) recommendations define PCN measurement and growth for different categories based on baseline cyst size. However, no data are available regarding PCN growth rate under the ACR-defined size categories. Purpose To assess growth of incidentally detected PCNs on long-term imaging follow-up using revised ACR recommendations and to evaluate the association between baseline imaging features and growth. Materials and Methods This retrospective study included PCNs with baseline imaging performed between January 2002 and May 2017, with two or more cross-sectional imaging studies performed at least 12 months apart. PCN assessment was based on ACR 2017 recommendations. Cyst features, including location, septations, and mural nodules and multiplicity, were noted. Time to cyst progression (growth by ACR criteria) was examined by using baseline PCN size, among other factors. Results A total of 646 cysts in 390 patients were followed up for a median of 50 months (range, 12-186 months). A total of 184 (28.5%) cysts increased in size, 52 (8.1%) decreased in size, and 410 (63.4%) remained stable. For groups in which baseline PCN size was smaller than 5 mm, 5-14 mm, 15-25 mm, and larger than 25 mm, growth was noted in seven (13.2%), 106 (28.9%), 49 (32.2%), and 22 (29.7%) cysts, respectively. ACR baseline size categories (subhazard ratio: 2.8 [5-14-mm PCN group], 3.4 [15-25-mm PCN group], and 2.7 [>25 mm group], as compared with the <5 mm PCN group; P < .05 for each) demonstrated association with growth. Presence of mural nodules, septations, or lesion multiplicity failed to demonstrate association with growth. Among PCNs smaller than 5 mm at baseline, 100% of PCNs at 3-year follow-up and 94.2% of PCNs at 5-year follow-up were likely to remain stable. Conclusion American College of Radiology baseline size category of 15-25-mm pancreatic cystic neoplasms (PCNs) demonstrated the highest (3.1 times) likelihood of growth, as compared with the category of PCNs smaller than 5 mm. PCNs smaller than 5 mm at baseline did not demonstrate growth at 3-year imaging follow-up. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Pallavi Pandey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Ankur Pandey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Yan Luo
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Mounes Aliyari Ghasabeh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Pegah Khoshpouri
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Sanaz Ameli
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Anne Marie O’Broin-Lennon
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Marcia Canto
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Ralph H. Hruban
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Michael S. Goggins
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Christopher Wolfgang
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Ihab R. Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (P.P., A.P., Y.L., M.A.G., P.K., S.Z., I.R.K.) and the Departments of Medicine, Division of Gastroenterology and Hepatology (A.M.O.L., M.C., M.S.G.), Pathology (R.H.H., M.S.G.), and Surgery, Division of Surgical Oncology (C.W.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
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Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, Brugge WR, Berland LL, Pandharipande PV. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017; 14:911-923. [PMID: 28533111 DOI: 10.1016/j.jacr.2017.03.010] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 12/12/2022]
Abstract
The ACR Incidental Findings Committee (IFC) presents recommendations for managing pancreatic cysts that are incidentally detected on CT or MRI. These recommendations represent an update from the pancreatic component of the JACR 2010 white paper on managing incidental findings in the adrenal glands, kidneys, liver, and pancreas. The Pancreas Subcommittee-which included abdominal radiologists, a gastroenterologist, and a pancreatic surgeon-developed this algorithm. The recommendations draw from published evidence and expert opinion, and were finalized by informal iterative consensus. Algorithm branches successively categorize pancreatic cysts based on patient characteristics and imaging features. They terminate with an ascertainment of benignity and/or indolence (sufficient to discontinue follow-up), or a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected pancreatic cysts.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, NYU-Langone Medical Center, New York, New York.
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elliot Newman
- Department of Surgery, NYU-Langone Medical Center, New York, New York
| | - William R Brugge
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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Kwon JH, Kim SC, Song KB, Lee JH, Hwang DW, Park KM, Lee YJ. Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2014; 18:152-8. [PMID: 26155268 PMCID: PMC4492346 DOI: 10.14701/kjhbps.2014.18.4.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/14/2014] [Accepted: 10/30/2014] [Indexed: 12/20/2022]
Abstract
Backgrounds/Aims Appropriate management for multifocal branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas is still controversial. This study was intended to reveal surgical outcomes of surgical resection for multifocal BD-IPMNs, with BD-IPMNs in the remnant pancreas. Methods Between January 1995 and December 2013, 699 patients underwent the pancreatic resection due to IPMN of pancreas in our institution. Among them, 37 patients showed multifocal BD-IPMNs. After excluding patients who had BD-IPMNs completely resected, medical records of 22 patients with remained BD-IPMNs in the remnant pancreas were retrospectively reviewed. Results Mean patient age was 65±6.4 years. Types of surgery included central pancreatectomy (n=1), distal pancreatectomy (n=14), and standard pylorus-preserving pancreaticoduodenectomy (n=7). Specimen pathology showed that IPMN was either at low/intermediate-grade dysplasia (n=17) or at high-grade dysplasia (n=2). Three patients had IPMN associated with invasive carcinoma. Their mean follow-up period was 40.4 months. During follow-up, one mortality occurred 35.2 months after the operation which was not associated with IPMN. There was no clinically significant disease progression or recurrence of IPMN in the remnant pancreas during the follow-up period. Conclusions Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs. Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.
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Affiliation(s)
- Jae Hyun Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Min Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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