Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results from a Large Multicenter Cohort Study

Phillip S. Ge, Srinivas Gaddam, Joseph W. Keach, Daniel Mullady, Norio Fukami, Steven A. Edmundowicz, Riad R. Azar, Raj J. Shah, Faris M. Murad, Vladimir M. Kushnir, Kourosh F. Ghassemi, Alireza Sedarat, Rabindra R. Watson, Stuart K. Amateau, Brian C. Brauer, Roy D. Yen, Lindsay Hosford, Thomas Hollander, Timothy R. Donahue, Richard D. SchulickBarish H. Edil, Martin D. McCarter, Csaba Gajdos, Augustin R. Attwell, V. Raman Muthusamy, Dayna S. Early, Sachin Wani

Research output: Contribution to journalArticle

Abstract

Objective Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. Methods We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. Results 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82). Conclusions This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalPancreas
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • CEA - carcinoembryonic antigen
  • EUS - endoscopic ultrasound
  • FNA - fine-needle aspiration
  • IPMN - intraductal papillary mucinous neoplasm
  • IQR - interquartile range
  • Key Words/Abbreviations
  • MCN - mucinous cystic neoplasm
  • NMCN - nonmucinous cystic neoplasm
  • PCL - pancreatic cystic lesion
  • SD - standard deviation
  • endoscopic ultrasound
  • intraductal papillary mucinous neoplasms
  • mucinous cystic neoplasms
  • pancreatic cystic lesions
  • pancreatic cysts
  • surgical predictors

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

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    Ge, P. S., Gaddam, S., Keach, J. W., Mullady, D., Fukami, N., Edmundowicz, S. A., Azar, R. R., Shah, R. J., Murad, F. M., Kushnir, V. M., Ghassemi, K. F., Sedarat, A., Watson, R. R., Amateau, S. K., Brauer, B. C., Yen, R. D., Hosford, L., Hollander, T., Donahue, T. R., ... Wani, S. (2016). Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results from a Large Multicenter Cohort Study. Pancreas, 45(1), 51-57. https://doi.org/10.1097/MPA.0000000000000386