American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data

Singhi, Aatur D.; Zeh, Herbert J.; Brand, Randall E.; Nikiforova, Marina N.; Chennat, Jennifer; Fasanella, Kenneth E.; Khalid, Asif; Papachristou, Georgios I.; Slivka, Adam; Hogg, Melissa E.; Lee, Kenneth K.; Tsung, Allan; Zureikat, Amer H.; McGrath, Kevin

doi:10.1016/j.gie.2015.12.009

Cited by 145 publications

(109 citation statements)

References 49 publications

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“…From a clinical point of view, it seems that targeting "late neoplasia" as the diagnostic threshold may not seem the best approach for the patient due to the high lethality of these lesions once malignancy arises. In view of this, a recent study (95) aimed to assess the accuracy of the AGA guidelines in detecting advanced neoplasia. To do so, 225 patients with a PCL who underwent EUS-FNA were analyzed.…”

Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

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Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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“…One retrospective study found that using AGA guidelines on a cohort of 225 patients had lower sensitivity and specificity of 62% and 79% respectively for detecting advanced neoplasia. 13 Moreover, the guidelines would have missed 45% of IPMNs with adenocarcinoma or high-grade dysplasia.…”

Section: Guidelines For Screening Pancreatic Cystic Lesionsmentioning

confidence: 99%

An appraisal of pancreatic cyst fluid molecular markers

Modi

Pavurala

Krishna

2017

Int J Gastrointest Interv

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Pancreatic malignancy is the third leading cause of cancer related death in the United States with limited viable screening options. By the end of this decade, cancers are poised to become the leading cause of death with pancreatic cancer projected to be the second leading cause of cancer related mortality. Pancreatic cystic lesions (PCLs) are found in approximately 5%-14% of patients due to the increased utilization of cross-sectional imaging, with approximately 8%-10% of pancreatic cancers originating as PCLs. Current screening guidelines have shown discrepancies between morphologic characteristics of PCLs and identifying advanced pancreatic disease. Molecular analysis has emerged as a novel technology to aid in adequate diagnosis and management decisions of PCLs. Mucinous cysts including intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms have similar oncogenic mutations including KRAS, TP53, SMAD4, PIK3CA, PTEN, or CKDN2A, while GNAS and RNF43 mutations are specific only to IPMNs. Serous cystadenomas have been associated with a loss of tumor suppressor gene VHL, while solid-psuedopapillary neoplasms have an oncogenic mutation CTNNB1. A specific molecular marker to diagnose existing high-grade dysplasia or impending malignant transformation is yet to be identified. Moving forward it is important to advance technology in isolating and identifying high-risk molecular markers from cyst fluid while considering their increased utilization in the evaluation of PCLs.

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“…Singhi et al 58 conducted a retrospective study to assess the performance characteristics of the AGA guidelines and found that 45% of IPMNs with adenocarcinoma or high-grade dysplasia would have been missed. They also proposed a new a novel algorithmic pathway using molecular testing of pancreatic cyst fluid detecting advanced neoplasia with 100% sensitivity, 90% specificity, 79% positive predictive value, and 100% negative predictive value.…”

Section: Guidelines For Management Of Pancreatic Cystic Neoplasmsmentioning

confidence: 99%

Recent developments in endoscopic ultrasound-guided diagnosis and therapy of pancreatic cystic neoplasms

Kirtane

Bhutani

2017

Int J Gastrointest Interv

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This review highlights new developments in the field of endoscopic ultrasound (EUS)-guided diagnosis and therapy of pancreatic cystic neoplasms. Studies pertinent to pancreatic cyst diagnosis by morphology, namely diagnostic accuracies of various criteria such as pancreatic cyst size, pancreatic duct size, mural nodules and use of EUS contrast agent are discussed. Tissue acquisition during EUS using a novel brush for cytology as well as microforceps is explored further. The role of multiple emerging molecular markers such as CEA, BRAF, KRAS, and GNAS, to name a few, is covered in detail. Recent developments relating to the utility of micro-RNAs in the analysis of cyst fluid is explored. Needle based confocal laser endomicroscopy for pancreatic cyst imaging is a recent development, and findings from recent trials are discussed. Furthermore, recent data regarding the role of ablative therapies using alcohol, paclitaxel and radiofrequency ablation of cyst is covered. Also, given the multiplicity of guidelines regarding management of pancreatic cystic neoplasms, we discuss the merits and shortcoming of these guidelines.

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American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data

Cited by 145 publications

References 49 publications

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

An appraisal of pancreatic cyst fluid molecular markers

Recent developments in endoscopic ultrasound-guided diagnosis and therapy of pancreatic cystic neoplasms

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