Patient- and cyst-related factors for improved prediction of malignancy within cystic lesions of the pancreas.
OBJECTIVE
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) > or =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 > or =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.
Buscaglia
Jonathan M
JM
Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jmbuscaglia@notes.cc.sunysb.edu
Giday
Samuel A
SA
Kantsevoy
Sergey V
SV
Jagannath
Sanjay B
SB
Magno
Priscilla
P
Wolfgang
Christopher L
CL
Daniels
Jason A
JA
Canto
Marcia I
MI
Okolo Iii
Patrick I
PI
D002272:Carcinoembryonic Antigen / Q000032:analysis; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010181:Pancreatic Cyst / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011230:Precancerous Conditions / Q000175:diagnosis; D012372:ROC Curve; D012189:Retrospective Studies
D002272:Carcinoembryonic Antigen