A prediction rule for estimating pancreatic cancer risk in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology.
OBJECTIVE
Considerable false-negative endoscopic ultrasound guided fine needle aspiration (EUS-FNA) findings exist in chronic pancreatitis patients with focal pancreatic mass lesions. Our aim was to develop a prediction rule to stratify risk for pancreatic cancer in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology.


METHODS
A total of 138 eligible consecutive patients were identified from three hospitals between January 2000 and May 2008. A final diagnosis of pancreatic mass lesions was confirmed histologically or verified by a follow-up of at least 12 months. A prediction rule was developed from a logistic regression model by using a regression coefficient-based scoring method, and then internally validated by using bootstrapping.


RESULTS
The rate of pancreatic cancer in the cohort was 18.1%. The prediction rule, which was scored from 0 to 10 points, comprised five variables: sex, mass location, mass number, direct bilirubin, and CA 19-9. Among the 87.7% of patients with low-risk scores (≤ 3), the risk of pancreatic cancer was 13.2%; by comparison, this risk was 52.9% (p < 0.001) among the 12.3% of patients with high-risk scores (> 3). If further invasive tests were used for patients with high risk, 36% of patients with pancreatic cancer would not be missed. The prediction rule had good discrimination (area under the receiver operating characteristic curve, 0.72) and calibration (p = 0.96).


CONCLUSIONS
The prediction rule can provide available risk stratification for pancreatic cancer in chronic pancreatitis patients with focal mass lesions with prior negative EUS-FNA cytology. Application of risk stratification may improve clinical decision making.
Center for Clinical Epidemiology and Evidence-based Medicine, Second Military Medical University, Shanghai, China.
Quan-Cai
QC
Cai
Yan
Y
Chen
Yi
Y
Xiao
Wei
W
Zhu
Qin-Feng
QF
Xu
Liang
L
Zhong
Shi-Yao
SY
Chen
Min-Min
MM
Zhang
Luo-Wei
LW
Wang
Zhao-Shen
ZS
Li
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D044963:Biopsy, Fine-Needle; D018395:CA-19-9 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D019160:Endosonography; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis*; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012306:Risk; D047368:Tumor Burden; D018084:Ultrasonography, Interventional; D055815:Young Adult
D018395:CA-19-9 Antigen; D001663:Bilirubin