Evaluation of the 2015 AGA guidelines on pancreatic cystic neoplasms in a large surgically confirmed multicenter cohort.
Background and study aimsThe American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs.Patients and methodsA retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 - 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated.ResultsThree hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 - 92.1), 69.1 % specificity (95 % CI 62.9 - 74.8), 37.2 % positive predictive value (95 % CI 28.6 - 46.4), 95.0 % negative predictive value (95 % CI 90.7 - 97.7), and 71.7 % accuracy (95 % CI 67.4 - 74.6).ConclusionsThe 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines. Meeting presentations: Presented in part at Digestive Diseases Week 2016.
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Phillip S
PS
Ge
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
V Raman
VR
Muthusamy
Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States.
Srinivas
S
Gaddam
Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States.
Diana-Marie
DM
Jaiyeola
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Stephen
S
Kim
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Alireza
A
Sedarat
University of California Los Angeles David Geffen School of Medicine - Department of Surgery, Los Angeles, California, United States.
Timothy R
TR
Donahue
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
Lindsay
L
Hosford
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
Robert H
RH
Wilson
Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States.
David P
DP
Grande
Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States.
Rajesh N
RN
Keswani
Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States.
Vladimir M
VM
Kushnir
Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States.
Daniel
D
Mullady
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
Steven A
SA
Edmundowicz
Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States.
Dayna S
DS
Early
Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, United States.
Srinadh
S
Komanduri
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
Sachin
S
Wani
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Rabindra R
RR
Watson