title: Role of a multidisciplinary clinic in the management of patients with pancreatic cysts: a single-center cohort study.
abstract: BACKGROUND
  Incidental pancreatic cysts are common, a small number of which are premalignant or malignant. Multidisciplinary care has been shown to alter management and improve outcomes in many types of cancers, but its role has not been examined in patients with pancreatic cysts. We assessed the effect of a multidisciplinary pancreatic cyst clinic (MPCC) on the diagnosis and management of patients with pancreatic cysts.
  
  
  METHODS
  The referring institution and MPCC diagnosis and management plan were recorded. Patient were placed into one of five categories-no, low, intermediate, or high risk of malignancy within the cyst, and malignant cyst-on the basis of their diagnosis. Patients were assigned one of four management options: surveillance, surgical resection, further evaluation, or discharge with no further follow-up required. The MPCC was deemed to have altered patient care if the patient was assigned a different risk or management category after the MPCC review.
  
  
  RESULTS
  Referring institution records were available for 262 patients (198 women; mean age 62.7 years), with data on risk category available in 138 patients and management category in 225. The most common diagnosis was branch duct intraductal papillary mucinous neoplasm. MPCC review altered the risk category in 11 (8.0%) of 138 patients. The management category was altered in 68 (30.2%) of 225 patients. Management was increased in 52 patients, including 22 patients who were recommended surgical resection. Management was decreased in 16 patients, including 10 who had their recommendation changed from surgery to surveillance.
  
  
  CONCLUSIONS
  MPCC is helpful and alters the management over 30% of patients.
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Manos
authors.affiliation: Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.affiliation: Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Siva P
authors.initials: SP
authors.lastname: Raman
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ashley
authors.initials: A
authors.lastname: Salamone
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Vandhana
authors.initials: V
authors.lastname: Kiswani
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010181:Pancreatic Cyst / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult