Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group

Fung, Christopher; Bigam, David L.; Wong, Clarence; Hurrell, Casey; Bird, James; Brahm, Gary; Kirkpatrick, Iain D.C.

doi:10.1177/08465371211021079

Cited by 8 publications

(13 citation statements)

References 42 publications

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“…Notably, patients with cystic lesions demonstrating worrisome features (e.g., mural nodule, focal wall thickening) or simple cysts larger than 2.4 cm should be referred to gastroenterology for additional work up potentially including endoscopic ultrasound þ/-FNA due to the higher risk of mucinous neoplasm. 4 Given the increased frequency of detection of pancreatic incidentalomas, these evidence-based recommendations will help to ensure that patients with significant findings are not missed or lost to follow up, balanced with an avoidance of excessive imaging in patients with minimal risk of malignancy.…”

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confidence: 99%

“…In this issue of the CARJ, Fung et al on behalf of the Canadian Association of Radiologists (CAR) Incidental Findings Working Group present Canadian guidelines for the management of pancreatic incidentalomas, with a particular emphasis on incidental pancreatic cysts. 4 The CAR Incidental Findings Working Group members should be commended for providing a concise and an updated summary on this controversial topic.…”

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confidence: 99%

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confidence: 99%

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Incidental Pancreatic Findings: When to Follow Up?

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2021

Can Assoc Radiol J

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Incidental Pancreatic Findings: When to Follow Up?

Patlas

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“…Previously published North American guidelines include the American Gastroenterology Association guidelines (AGAG) and the American College of Radiology guidelines (ACRG) ( 13 , 14 ). The Canadian Association of Radiologists Incidental Findings Working Group recently published Multidisciplinary Pancreatic Cyst Guidelines (CARG) intended to simplify recommendations, improve adherence and create cost-effective guidelines without compromising safety ( 15 ). Notable changes within CARGs include stopping surveillance in patients over age 75 and for low risk PCLs <0.5 cm ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…The Canadian Association of Radiologists Incidental Findings Working Group recently published Multidisciplinary Pancreatic Cyst Guidelines (CARG) intended to simplify recommendations, improve adherence and create cost-effective guidelines without compromising safety ( 15 ). Notable changes within CARGs include stopping surveillance in patients over age 75 and for low risk PCLs <0.5 cm ( 15 ). Other key aspects of all three guidelines are summarized in Table 1 .…”

Section: Introductionmentioning

confidence: 99%

Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines

Verhoeff

Webb

Krys

et al. 2023

Journal of the Canadian Association of Gastroenterology

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Background Pancreatic cystic lesions (PCLs) are common, with several guidelines providing surveillance recommendations. The Canadian Association of Radiologists published surveillance guidelines (CARGs) intended to provide simplified, cost-effective and safe recommendations. This study aimed to evaluate cost savings of CARGs compared to other North American guidelines including American Gastroenterology Association guidelines (AGAG) and American College of Radiology guidelines (ACRG), and to evaluate CARG safety and uptake. Methods This is a multicentre retrospective study evaluating adults with PCL from a single health zone. MRIs completed from September 2018–2019, one year after local CARG guideline implementation, were reviewed to identify PCLs. All imaging following 3–4 years of CARG implementation was reviewed to evaluate true costs, missed malignancy and guideline uptake. Modelling, including MRI and consultation, predicted and compared costs associated with surveillance based on CARGs, AGAGs and ACRGs. Results 6698 abdominal MRIs were reviewed with 1001 (14.9%) identifying PCL. Application of CARGs over 3.1 years demonstrated a >70% cost reduction compared to other guidelines. Similarly, the modelled cost of surveillance for 10-years for each guideline was $516,183, $1,908,425 and $1,924,607 for CARGs, AGAGs and ACRGs respectively. Of patients suggested to not require further surveillance per CARGs, approximately 1% develop malignancy with fewer being candidates for surgical resection. Overall, 44.8% of initial PCL reports provided CARG recommendations while 54.3% of PCLs were followed as per CARGs. Conclusions CARGs are safe and offer substantial cost and opportunity savings for PCL surveillance. These findings support Canada-wide implementation with close monitoring of consultation requirements and missed diagnoses.

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Pancreatic Cystic Lesions on MRI: What Is The Likelihood of a Present or Future Diagnosis of Pancreatic Carcinoma?

Alwahbi

Larocque

Kulkarni

et al. 2022

Magnetic Resonance Imaging

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BackgroundPancreatic cystic lesions (PCLs) are followed for years due to older and likely biased works demonstrating a strong association with pancreatic carcinoma; more recent data are needed clarifying this relationship.PurposeTo determine the association between PCLs on MRI and a synchronous or future diagnosis of pancreatic carcinoma.Study typeSingle‐center retrospective cohort.PopulationA total of 192 patients (111 female, 58%) with median age 66 years (range 26–87 years) with PCLs on abdominal MRI from 2011 to 2016.Field Strength/Sequences1.5 T and 3 T, including T2WI, T1WI, diffusion weighted imaging and contrast‐enhanced T1WI.AssessmentEach PCL was reviewed independently by 2 of 10 fellowship‐trained abdominal radiologists. Fukuoka guideline worrisome features and high‐risk stigmata were evaluated. Follow‐up imaging and clinical notes were reviewed within a system that captures pancreatic carcinoma for the region, for a median follow‐up of 67 months (interquartile range: 43–88 months).Statistical TestsPancreatic carcinoma prevalence and incidence rate for future carcinoma with 95% confidence intervals (95% CI). Fisher exact test, logistic regression with odds ratios (OR) and the Wilcoxon rank‐sum test were used to assess PCL morphologic features with the Kolmogorov–Smirnov test used to assess for normality. P < 0.05 defined statistical significance.ResultsThe prevalence of pancreatic carcinoma on initial MRI showing a PCL was 2.4% (95% CI: 0.9%, 5.2%). Thickened/enhancing cyst wall was associated with pancreatic carcinoma, OR 52 (95% CI: 4.5, 1203). Of 189 patients with a PCL but without pancreatic carcinoma at the time of initial MRI, one developed high‐grade dysplasia and none developed invasive carcinoma for an incidence rate of 0.97 (95% CI: 0.02, 5.43) and 0 (95% CI: 0, 3.59) cases per 1000 person‐years, respectively.Data ConclusionA low percentage of patients with a PCL on MRI had a pancreatic carcinoma at the time of initial evaluation and none developed carcinoma over a median 67 months of follow‐up.Evidence Level3Technical Efficacy5

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Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group

Cited by 8 publications

References 42 publications

Incidental Pancreatic Findings: When to Follow Up?

Incidental Pancreatic Findings: When to Follow Up?

Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines

Pancreatic Cystic Lesions on MRI: What Is The Likelihood of a Present or Future Diagnosis of Pancreatic Carcinoma?

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