Original Paper

Patient- and Cyst-Related Factors for Improved Prediction of Malignancy within Cystic Lesions of the Pancreas
Jonathan M. Buscaglia^{a, d}, Samuel A. Giday^a, Sergey V. Kantsevoy^a, Sanjay B. Jagannath^a, Priscilla Magno^a, Christopher L. Wolfgang^b, Jason A. Daniels^c, Marcia I. Canto^a, Patrick I. Okolo, III^a

Departments of
^aMedicine,
^bSurgery, and
^cPathology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Md., and
^dDepartment of Medicine, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, N.Y., USA

Address of Corresponding Author

Pancreatology 2009;9:631-638 (DOI: 10.1159/000181173)

  Key Words

• Carcinoma in situ
• Carcinoembryonic antigen
• Endoscopic ultrasound
• Electronic physician record
• Intraductal papillary mucinous neoplasms
• Invasive cancer
• Mucinous cystic neoplasms

  Abstract

Background and Aims: Early diagnosis of cancer in pancreatic cysts is important for timely referral to surgery. The aim of this study was to develop a predictive model for pancreatic cyst malignancy to improve patient selection for surgical resection. Methods: We performed retrospective analyses of endoscopic ultrasound (EUS) and pathology databases identifying pancreatic cysts with available final pathological diagnoses. Main-duct intraductal papillary mucinous neoplasms (IPMNs) were excluded due to the clear indication for surgery. Patient demographics and symptoms, cyst morphology, and cyst fluid characteristics were studied as candidate risk factors for malignancy. Results: 270 patients with pancreatic cysts were identified and analyzed (41% men, mean age 61.8 years). Final pathological diagnoses were branch-duct IPMN (n = 118, 50% malignant), serous cystadenoma (n = 71), pseudocyst (n = 37), mucinous cyst adenoma/adenocarcinoma (n = 36), islet cell tumor (n = 4), simple cyst (n = 3), and ductal adenocarcinoma with cystic degeneration (n = 1). Optimal cut-off points for surgical resection were cyst fluid carcinoembryonic antigen (CEA) 3,594 ng/ml, age >50, and cyst size >1.5 cm. Cyst malignancy was independently associated with white race (OR = 4.1, p = 0.002), weight loss (OR = 3.9, p = 0.001), cyst size >1.5 cm (OR = 2.4, p = 0.012), and high CEA 3,594 (OR = 5.3, p = 0.04). In white patients >50 years old presenting with weight loss and cyst size >1.5 cm, the likelihood of malignancy was nearly sixfold greater than in those patients who had none of these factors (OR = 5.8, 95% CI = 2.1-16.1, p = 0.004). Conclusions: Risk factors other than cyst size are important for determination of malignancy in pancreatic cysts. Exceptionally high cyst fluid CEA levels and certain patient-related factors may help to better predict cyst malignancy and the need for surgical treatment.

Copyright © 2009 S. Karger AG, Basel and IAP

  Author Contacts

Jonathan M. Buscaglia, MD
100 Nicolls Road, Health Sciences Center, T-17, Rm 064
Stony Brook, NY 11794 (USA)
Tel. +1 631 444 2117, Fax +1 631 444 8886
E-Mail jmbuscaglia@notes.cc.sunysb.edu

  Article Information

The abstract from this article was presented as an AGA Poster of Distinction during Digestive Disease Week (DDW), Washington, D.C., 2007.

Received: May 29, 2008
Accepted after revision: October 24, 2008
Published online: August 4, 2009
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 4, Number of References : 30