Follow-up of incidentally detected pancreatic cystic neoplasms

Do baseline MRI and CT features predict cyst growth?

Pallavi Pandey, Ankur Pandey, Yan Luo, Mounes Aliyari Ghasabeh, Pegah Khoshpouri, Sanaz Ameli, Anne Marie O'Broin-Lennon, Marcia Canto, Ralph H. Hruban, Michael S Goggins, Christopher Wolfgang, Ihab R Kamel

Research output: Contribution to journalArticle

Abstract

Background: Incidental detection of pancreatic cystic neoplasm (PCN) has increased. Since a small percentage of PCNs possess malignant potential, management is challenging. The recently revised American College of Radiology (ACR) recommendations define PCN measurement and growth for different categories based on baseline cyst size. However, no data are available regarding PCN growth rate under the ACR-defined size categories. Purpose: To assess growth of incidentally detected PCNs on long-term imaging follow-up using revised ACR recommendations and to evaluate the association between baseline imaging features and growth. Materials and Methods: This retrospective study included PCNs with baseline imaging performed between January 2002 and May 2017, with two or more cross-sectional imaging studies performed at least 12 months apart. PCN assessment was based on ACR 2017 recommendations. Cyst features, including location, septations, and mural nodules and multiplicity, were noted. Time to cyst progression (growth by ACR criteria) was examined by using baseline PCN size, among other factors. Results: A total of 646 cysts in 390 patients were followed up for a median of 50 months (range, 12-186 months). A total of 184 (28.5%) cysts increased in size, 52 (8.1%) decreased in size, and 410 (63.4%) remained stable. For groups in which baseline PCN size was smaller than 5 mm, 5-14 mm, 15-25 mm, and larger than 25 mm, growth was noted in seven (13.2%), 106 (28.9%), 49 (32.2%), and 22 (29.7%) cysts, respectively. ACR baseline size categories (subhazard ratio: 2.8 [5-14-mm PCN group], 3.4 [15-25-mm PCN group], and 2.7 [.25 mm group], as compared with the ,5 mm PCN group; P , .05 for each) demonstrated association with growth. Presence of mural nodules, septations, or lesion multiplicity failed to demonstrate association with growth. Among PCNs smaller than 5 mm at baseline, 100% of PCNs at 3-year follow-up and 94.2% of PCNs at 5-year follow-up were likely to remain stable. Conclusion: American College of Radiology baseline size category of 15-25-mm pancreatic cystic neoplasms (PCNs) demonstrated the highest (3.1 times) likelihood of growth, as compared with the category of PCNs smaller than 5 mm. PCNs smaller than 5 mm at baseline did not demonstrate growth at 3-year imaging follow-up.

Original languageEnglish (US)
Pages (from-to)647-654
Number of pages8
JournalRadiology
Volume292
Issue number3
DOIs
StatePublished - Jan 1 2019

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Pancreatic Neoplasms
Cysts
Growth
Radiology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Follow-up of incidentally detected pancreatic cystic neoplasms : Do baseline MRI and CT features predict cyst growth? / Pandey, Pallavi; Pandey, Ankur; Luo, Yan; Ghasabeh, Mounes Aliyari; Khoshpouri, Pegah; Ameli, Sanaz; O'Broin-Lennon, Anne Marie; Canto, Marcia; Hruban, Ralph H.; Goggins, Michael S; Wolfgang, Christopher; Kamel, Ihab R.

In: Radiology, Vol. 292, No. 3, 01.01.2019, p. 647-654.

Research output: Contribution to journalArticle

Pandey, Pallavi ; Pandey, Ankur ; Luo, Yan ; Ghasabeh, Mounes Aliyari ; Khoshpouri, Pegah ; Ameli, Sanaz ; O'Broin-Lennon, Anne Marie ; Canto, Marcia ; Hruban, Ralph H. ; Goggins, Michael S ; Wolfgang, Christopher ; Kamel, Ihab R. / Follow-up of incidentally detected pancreatic cystic neoplasms : Do baseline MRI and CT features predict cyst growth?. In: Radiology. 2019 ; Vol. 292, No. 3. pp. 647-654.
@article{5c13aa642cf64f528227378092b0cd6e,
title = "Follow-up of incidentally detected pancreatic cystic neoplasms: Do baseline MRI and CT features predict cyst growth?",
abstract = "Background: Incidental detection of pancreatic cystic neoplasm (PCN) has increased. Since a small percentage of PCNs possess malignant potential, management is challenging. The recently revised American College of Radiology (ACR) recommendations define PCN measurement and growth for different categories based on baseline cyst size. However, no data are available regarding PCN growth rate under the ACR-defined size categories. Purpose: To assess growth of incidentally detected PCNs on long-term imaging follow-up using revised ACR recommendations and to evaluate the association between baseline imaging features and growth. Materials and Methods: This retrospective study included PCNs with baseline imaging performed between January 2002 and May 2017, with two or more cross-sectional imaging studies performed at least 12 months apart. PCN assessment was based on ACR 2017 recommendations. Cyst features, including location, septations, and mural nodules and multiplicity, were noted. Time to cyst progression (growth by ACR criteria) was examined by using baseline PCN size, among other factors. Results: A total of 646 cysts in 390 patients were followed up for a median of 50 months (range, 12-186 months). A total of 184 (28.5{\%}) cysts increased in size, 52 (8.1{\%}) decreased in size, and 410 (63.4{\%}) remained stable. For groups in which baseline PCN size was smaller than 5 mm, 5-14 mm, 15-25 mm, and larger than 25 mm, growth was noted in seven (13.2{\%}), 106 (28.9{\%}), 49 (32.2{\%}), and 22 (29.7{\%}) cysts, respectively. ACR baseline size categories (subhazard ratio: 2.8 [5-14-mm PCN group], 3.4 [15-25-mm PCN group], and 2.7 [.25 mm group], as compared with the ,5 mm PCN group; P , .05 for each) demonstrated association with growth. Presence of mural nodules, septations, or lesion multiplicity failed to demonstrate association with growth. Among PCNs smaller than 5 mm at baseline, 100{\%} of PCNs at 3-year follow-up and 94.2{\%} of PCNs at 5-year follow-up were likely to remain stable. Conclusion: American College of Radiology baseline size category of 15-25-mm pancreatic cystic neoplasms (PCNs) demonstrated the highest (3.1 times) likelihood of growth, as compared with the category of PCNs smaller than 5 mm. PCNs smaller than 5 mm at baseline did not demonstrate growth at 3-year imaging follow-up.",
author = "Pallavi Pandey and Ankur Pandey and Yan Luo and Ghasabeh, {Mounes Aliyari} and Pegah Khoshpouri and Sanaz Ameli and O'Broin-Lennon, {Anne Marie} and Marcia Canto and Hruban, {Ralph H.} and Goggins, {Michael S} and Christopher Wolfgang and Kamel, {Ihab R}",
year = "2019",
month = "1",
day = "1",
doi = "10.1148/radiol.2019181686",
language = "English (US)",
volume = "292",
pages = "647--654",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
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TY - JOUR

T1 - Follow-up of incidentally detected pancreatic cystic neoplasms

T2 - Do baseline MRI and CT features predict cyst growth?

AU - Pandey, Pallavi

AU - Pandey, Ankur

AU - Luo, Yan

AU - Ghasabeh, Mounes Aliyari

AU - Khoshpouri, Pegah

AU - Ameli, Sanaz

AU - O'Broin-Lennon, Anne Marie

AU - Canto, Marcia

AU - Hruban, Ralph H.

AU - Goggins, Michael S

AU - Wolfgang, Christopher

AU - Kamel, Ihab R

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Incidental detection of pancreatic cystic neoplasm (PCN) has increased. Since a small percentage of PCNs possess malignant potential, management is challenging. The recently revised American College of Radiology (ACR) recommendations define PCN measurement and growth for different categories based on baseline cyst size. However, no data are available regarding PCN growth rate under the ACR-defined size categories. Purpose: To assess growth of incidentally detected PCNs on long-term imaging follow-up using revised ACR recommendations and to evaluate the association between baseline imaging features and growth. Materials and Methods: This retrospective study included PCNs with baseline imaging performed between January 2002 and May 2017, with two or more cross-sectional imaging studies performed at least 12 months apart. PCN assessment was based on ACR 2017 recommendations. Cyst features, including location, septations, and mural nodules and multiplicity, were noted. Time to cyst progression (growth by ACR criteria) was examined by using baseline PCN size, among other factors. Results: A total of 646 cysts in 390 patients were followed up for a median of 50 months (range, 12-186 months). A total of 184 (28.5%) cysts increased in size, 52 (8.1%) decreased in size, and 410 (63.4%) remained stable. For groups in which baseline PCN size was smaller than 5 mm, 5-14 mm, 15-25 mm, and larger than 25 mm, growth was noted in seven (13.2%), 106 (28.9%), 49 (32.2%), and 22 (29.7%) cysts, respectively. ACR baseline size categories (subhazard ratio: 2.8 [5-14-mm PCN group], 3.4 [15-25-mm PCN group], and 2.7 [.25 mm group], as compared with the ,5 mm PCN group; P , .05 for each) demonstrated association with growth. Presence of mural nodules, septations, or lesion multiplicity failed to demonstrate association with growth. Among PCNs smaller than 5 mm at baseline, 100% of PCNs at 3-year follow-up and 94.2% of PCNs at 5-year follow-up were likely to remain stable. Conclusion: American College of Radiology baseline size category of 15-25-mm pancreatic cystic neoplasms (PCNs) demonstrated the highest (3.1 times) likelihood of growth, as compared with the category of PCNs smaller than 5 mm. PCNs smaller than 5 mm at baseline did not demonstrate growth at 3-year imaging follow-up.

AB - Background: Incidental detection of pancreatic cystic neoplasm (PCN) has increased. Since a small percentage of PCNs possess malignant potential, management is challenging. The recently revised American College of Radiology (ACR) recommendations define PCN measurement and growth for different categories based on baseline cyst size. However, no data are available regarding PCN growth rate under the ACR-defined size categories. Purpose: To assess growth of incidentally detected PCNs on long-term imaging follow-up using revised ACR recommendations and to evaluate the association between baseline imaging features and growth. Materials and Methods: This retrospective study included PCNs with baseline imaging performed between January 2002 and May 2017, with two or more cross-sectional imaging studies performed at least 12 months apart. PCN assessment was based on ACR 2017 recommendations. Cyst features, including location, septations, and mural nodules and multiplicity, were noted. Time to cyst progression (growth by ACR criteria) was examined by using baseline PCN size, among other factors. Results: A total of 646 cysts in 390 patients were followed up for a median of 50 months (range, 12-186 months). A total of 184 (28.5%) cysts increased in size, 52 (8.1%) decreased in size, and 410 (63.4%) remained stable. For groups in which baseline PCN size was smaller than 5 mm, 5-14 mm, 15-25 mm, and larger than 25 mm, growth was noted in seven (13.2%), 106 (28.9%), 49 (32.2%), and 22 (29.7%) cysts, respectively. ACR baseline size categories (subhazard ratio: 2.8 [5-14-mm PCN group], 3.4 [15-25-mm PCN group], and 2.7 [.25 mm group], as compared with the ,5 mm PCN group; P , .05 for each) demonstrated association with growth. Presence of mural nodules, septations, or lesion multiplicity failed to demonstrate association with growth. Among PCNs smaller than 5 mm at baseline, 100% of PCNs at 3-year follow-up and 94.2% of PCNs at 5-year follow-up were likely to remain stable. Conclusion: American College of Radiology baseline size category of 15-25-mm pancreatic cystic neoplasms (PCNs) demonstrated the highest (3.1 times) likelihood of growth, as compared with the category of PCNs smaller than 5 mm. PCNs smaller than 5 mm at baseline did not demonstrate growth at 3-year imaging follow-up.

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DO - 10.1148/radiol.2019181686

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