Delayed growth in incidental pancreatic cysts: Are the current American College of Radiology recommendations for follow-up appropriate?

Olga R. Brook, Peter Beddy, Jay Pahade, Corey Couto, Ian Brennan, Payal Patel, Alexander Brook, Ivan Pedrosa

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: To evaluate growth kinetics of asymptomatic small (,2 cm) incidental pancreatic cysts and to assess potential implications of these in the context of current American College of Radiology recommendations. Materials and Methods: This institutional review board-approved HIPAA-compliant retrospective study with waiver of informed consent included patients with asymptomatic small incidental pancreatic cysts (diameter, 5-20 mm) with two or more magnetic resonance (MR) examinations performed at least 6 months apart at a tertiary institution. The largest cyst dimension was measured on T2-weighted single-shot fast spin-echo images by one of six radiologists (1-3 years of experience) who were trained to measure pancreatic cysts in a similar manner. All analysis was conducted at the patient level by choosing the cyst that exhibited the greatest growth over the follow-up period in each patient. Fisher exact, χ2, and Kruskal-Wallis tests and analysis of variance were used to test correlation between cyst characteristics and growth. Results: A total of 259 patients (mean age, 65 years ± 11 [standard deviation], male-to-female ratio, 42:58) with 370 asymptomatic small incidental pancreatic cysts were included. At presentation, median cyst size was 9.4 mm (interquartile range [IQR], 7.0-12.2 mm), and 64 patients (25%; 95% confidence interval [CI]: 20, 30) had septations. The median imaging follow-up period was 2.2 years (IQR, 1.2-3.9 years; range, 0.5-11.0 years), with a median of three MR examinations (IQR, two to four examinations) per patient. In 171 (66%; 95% CI: 60, 72) of the 259 patients, cysts remained stable; in 18 (7%; 95% CI: 4, 11), cysts shrank; and in 70 (27%; 95% CI: 22, 33), cysts grew (median total growth and median annual growth of 4.8 mm and 2.3 mm/y, respectively). Age, cyst size, and cyst septation at presentation were not predictive of growth. Overall, 29 (11%), 16 (6%), and four (1.5%) of the cysts increased in size after 1, 2, and 3 years of initial stability, respectively. Of the 18 patients who underwent pancreatic surgery, only one patient with an intraductal papillary mucinous neoplasm had high-grade dysplasia. One patient developed pancreatic adenocarcinoma remotely at the location of the pancreatic cyst diagnosed 11 months prior. Conclusion: In the majority of patients, asymptomatic small incidental pancreatic cysts remained stable during a median follow-up period of 2.2 years; however, in 27% of patients, cysts increased in size over time, with 11% growing after an initial 1-year period of stability. Current American College of Radiology recommendations to discontinue imaging follow-up after 1 year of stability may need to be reevaluated.

Original languageEnglish (US)
Pages (from-to)752-761
Number of pages10
JournalRadiology
Volume278
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Pancreatic Cyst
Radiology
Cysts
Growth
Confidence Intervals
Magnetic Resonance Spectroscopy
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Delayed growth in incidental pancreatic cysts : Are the current American College of Radiology recommendations for follow-up appropriate? / Brook, Olga R.; Beddy, Peter; Pahade, Jay; Couto, Corey; Brennan, Ian; Patel, Payal; Brook, Alexander; Pedrosa, Ivan.

In: Radiology, Vol. 278, No. 3, 01.03.2016, p. 752-761.

Research output: Contribution to journalArticle

Brook, Olga R. ; Beddy, Peter ; Pahade, Jay ; Couto, Corey ; Brennan, Ian ; Patel, Payal ; Brook, Alexander ; Pedrosa, Ivan. / Delayed growth in incidental pancreatic cysts : Are the current American College of Radiology recommendations for follow-up appropriate?. In: Radiology. 2016 ; Vol. 278, No. 3. pp. 752-761.
@article{d6ad5002291b4e4eade1234ad9949c2d,
title = "Delayed growth in incidental pancreatic cysts: Are the current American College of Radiology recommendations for follow-up appropriate?",
abstract = "Purpose: To evaluate growth kinetics of asymptomatic small (,2 cm) incidental pancreatic cysts and to assess potential implications of these in the context of current American College of Radiology recommendations. Materials and Methods: This institutional review board-approved HIPAA-compliant retrospective study with waiver of informed consent included patients with asymptomatic small incidental pancreatic cysts (diameter, 5-20 mm) with two or more magnetic resonance (MR) examinations performed at least 6 months apart at a tertiary institution. The largest cyst dimension was measured on T2-weighted single-shot fast spin-echo images by one of six radiologists (1-3 years of experience) who were trained to measure pancreatic cysts in a similar manner. All analysis was conducted at the patient level by choosing the cyst that exhibited the greatest growth over the follow-up period in each patient. Fisher exact, χ2, and Kruskal-Wallis tests and analysis of variance were used to test correlation between cyst characteristics and growth. Results: A total of 259 patients (mean age, 65 years ± 11 [standard deviation], male-to-female ratio, 42:58) with 370 asymptomatic small incidental pancreatic cysts were included. At presentation, median cyst size was 9.4 mm (interquartile range [IQR], 7.0-12.2 mm), and 64 patients (25{\%}; 95{\%} confidence interval [CI]: 20, 30) had septations. The median imaging follow-up period was 2.2 years (IQR, 1.2-3.9 years; range, 0.5-11.0 years), with a median of three MR examinations (IQR, two to four examinations) per patient. In 171 (66{\%}; 95{\%} CI: 60, 72) of the 259 patients, cysts remained stable; in 18 (7{\%}; 95{\%} CI: 4, 11), cysts shrank; and in 70 (27{\%}; 95{\%} CI: 22, 33), cysts grew (median total growth and median annual growth of 4.8 mm and 2.3 mm/y, respectively). Age, cyst size, and cyst septation at presentation were not predictive of growth. Overall, 29 (11{\%}), 16 (6{\%}), and four (1.5{\%}) of the cysts increased in size after 1, 2, and 3 years of initial stability, respectively. Of the 18 patients who underwent pancreatic surgery, only one patient with an intraductal papillary mucinous neoplasm had high-grade dysplasia. One patient developed pancreatic adenocarcinoma remotely at the location of the pancreatic cyst diagnosed 11 months prior. Conclusion: In the majority of patients, asymptomatic small incidental pancreatic cysts remained stable during a median follow-up period of 2.2 years; however, in 27{\%} of patients, cysts increased in size over time, with 11{\%} growing after an initial 1-year period of stability. Current American College of Radiology recommendations to discontinue imaging follow-up after 1 year of stability may need to be reevaluated.",
author = "Brook, {Olga R.} and Peter Beddy and Jay Pahade and Corey Couto and Ian Brennan and Payal Patel and Alexander Brook and Ivan Pedrosa",
year = "2016",
month = "3",
day = "1",
doi = "10.1148/radiol.2015140972",
language = "English (US)",
volume = "278",
pages = "752--761",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

TY - JOUR

T1 - Delayed growth in incidental pancreatic cysts

T2 - Are the current American College of Radiology recommendations for follow-up appropriate?

AU - Brook, Olga R.

AU - Beddy, Peter

AU - Pahade, Jay

AU - Couto, Corey

AU - Brennan, Ian

AU - Patel, Payal

AU - Brook, Alexander

AU - Pedrosa, Ivan

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Purpose: To evaluate growth kinetics of asymptomatic small (,2 cm) incidental pancreatic cysts and to assess potential implications of these in the context of current American College of Radiology recommendations. Materials and Methods: This institutional review board-approved HIPAA-compliant retrospective study with waiver of informed consent included patients with asymptomatic small incidental pancreatic cysts (diameter, 5-20 mm) with two or more magnetic resonance (MR) examinations performed at least 6 months apart at a tertiary institution. The largest cyst dimension was measured on T2-weighted single-shot fast spin-echo images by one of six radiologists (1-3 years of experience) who were trained to measure pancreatic cysts in a similar manner. All analysis was conducted at the patient level by choosing the cyst that exhibited the greatest growth over the follow-up period in each patient. Fisher exact, χ2, and Kruskal-Wallis tests and analysis of variance were used to test correlation between cyst characteristics and growth. Results: A total of 259 patients (mean age, 65 years ± 11 [standard deviation], male-to-female ratio, 42:58) with 370 asymptomatic small incidental pancreatic cysts were included. At presentation, median cyst size was 9.4 mm (interquartile range [IQR], 7.0-12.2 mm), and 64 patients (25%; 95% confidence interval [CI]: 20, 30) had septations. The median imaging follow-up period was 2.2 years (IQR, 1.2-3.9 years; range, 0.5-11.0 years), with a median of three MR examinations (IQR, two to four examinations) per patient. In 171 (66%; 95% CI: 60, 72) of the 259 patients, cysts remained stable; in 18 (7%; 95% CI: 4, 11), cysts shrank; and in 70 (27%; 95% CI: 22, 33), cysts grew (median total growth and median annual growth of 4.8 mm and 2.3 mm/y, respectively). Age, cyst size, and cyst septation at presentation were not predictive of growth. Overall, 29 (11%), 16 (6%), and four (1.5%) of the cysts increased in size after 1, 2, and 3 years of initial stability, respectively. Of the 18 patients who underwent pancreatic surgery, only one patient with an intraductal papillary mucinous neoplasm had high-grade dysplasia. One patient developed pancreatic adenocarcinoma remotely at the location of the pancreatic cyst diagnosed 11 months prior. Conclusion: In the majority of patients, asymptomatic small incidental pancreatic cysts remained stable during a median follow-up period of 2.2 years; however, in 27% of patients, cysts increased in size over time, with 11% growing after an initial 1-year period of stability. Current American College of Radiology recommendations to discontinue imaging follow-up after 1 year of stability may need to be reevaluated.

AB - Purpose: To evaluate growth kinetics of asymptomatic small (,2 cm) incidental pancreatic cysts and to assess potential implications of these in the context of current American College of Radiology recommendations. Materials and Methods: This institutional review board-approved HIPAA-compliant retrospective study with waiver of informed consent included patients with asymptomatic small incidental pancreatic cysts (diameter, 5-20 mm) with two or more magnetic resonance (MR) examinations performed at least 6 months apart at a tertiary institution. The largest cyst dimension was measured on T2-weighted single-shot fast spin-echo images by one of six radiologists (1-3 years of experience) who were trained to measure pancreatic cysts in a similar manner. All analysis was conducted at the patient level by choosing the cyst that exhibited the greatest growth over the follow-up period in each patient. Fisher exact, χ2, and Kruskal-Wallis tests and analysis of variance were used to test correlation between cyst characteristics and growth. Results: A total of 259 patients (mean age, 65 years ± 11 [standard deviation], male-to-female ratio, 42:58) with 370 asymptomatic small incidental pancreatic cysts were included. At presentation, median cyst size was 9.4 mm (interquartile range [IQR], 7.0-12.2 mm), and 64 patients (25%; 95% confidence interval [CI]: 20, 30) had septations. The median imaging follow-up period was 2.2 years (IQR, 1.2-3.9 years; range, 0.5-11.0 years), with a median of three MR examinations (IQR, two to four examinations) per patient. In 171 (66%; 95% CI: 60, 72) of the 259 patients, cysts remained stable; in 18 (7%; 95% CI: 4, 11), cysts shrank; and in 70 (27%; 95% CI: 22, 33), cysts grew (median total growth and median annual growth of 4.8 mm and 2.3 mm/y, respectively). Age, cyst size, and cyst septation at presentation were not predictive of growth. Overall, 29 (11%), 16 (6%), and four (1.5%) of the cysts increased in size after 1, 2, and 3 years of initial stability, respectively. Of the 18 patients who underwent pancreatic surgery, only one patient with an intraductal papillary mucinous neoplasm had high-grade dysplasia. One patient developed pancreatic adenocarcinoma remotely at the location of the pancreatic cyst diagnosed 11 months prior. Conclusion: In the majority of patients, asymptomatic small incidental pancreatic cysts remained stable during a median follow-up period of 2.2 years; however, in 27% of patients, cysts increased in size over time, with 11% growing after an initial 1-year period of stability. Current American College of Radiology recommendations to discontinue imaging follow-up after 1 year of stability may need to be reevaluated.

UR - http://www.scopus.com/inward/record.url?scp=84959449525&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959449525&partnerID=8YFLogxK

U2 - 10.1148/radiol.2015140972

DO - 10.1148/radiol.2015140972

M3 - Article

C2 - 26348231

AN - SCOPUS:84959449525

VL - 278

SP - 752

EP - 761

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 3

ER -