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- W2890439496 abstract "Background: PancraGEN is a malignancy risk score for pancreatic cysts integrating cyst fluid DNA/molecular profile and clinical criteria (IMP.) Aside from main pancreatic duct diameter (MPD), integrated clinical criteria (CEA, growth rate, and cyst size) are not International Consensus Guidelines high-risk stigmata. We sought to determine if exclusion of all clinical criteria except MPD could simplify the IMP and better predict IPMN malignancy. Methods: A retrospective review of a prospective database of 1100 patients with IPMN from a single institution was performed. Of these, 285 had PancraGEN testing with non-malignant cytology. Following testing, 100 underwent surgery and 185 underwent surveillance for ≥23 months. IMP sensitivity (Sn,) specificity (Sp,) and accuracy for malignancy was compared to DNA/molecular profile including only MPD ≥10mm (IMP*.) Malignant outcomes were invasive IPMN/adenocarcinoma on surgical pathology, biopsy-proven adenocarcinoma during surveillance, or radiographic mesenteric vascular invasion or metastatic disease. Results: IMP* had higher Sp and accuracy for predicting malignancy compared to IMP in surgery + surveillance patients (Sp 90% vs 74%; Accuracy 90% vs 74%.) However, IMP was more sensitive for predicting malignancy compared to IMP* for the surgery + surveillance group (80% vs 70%.) Trends were similar in surgery patients alone. Conclusion: Inclusion of multiple clinical criteria in IMP captures more malignant cases than IMP* but with less specificity and accuracy. Thus, more patients without malignancy are improperly identified and may be subject to unnecessary surgery. IMP* excludes clinical factors that are unreliable predictors of malignant risk resulting in greater accuracy in predicting malignancy and more selectivity in who is recommended for surgery.Tabled 1IMP*IMPSensitivitySurgery + Surveillance70%80%Surgery Alone70%80%SpecificitySurgery + Surveillance90%74%Surgery Alone82%59%AccuracySurgery + Surveillance90%74%Surgery Alone81%61% Open table in a new tab" @default.
- W2890439496 created "2018-09-27" @default.
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- W2890439496 date "2018-03-01" @default.
- W2890439496 modified "2023-09-27" @default.
- W2890439496 title "Clinical criteria for integrated molecular pathology in IPMN: less is more" @default.
- W2890439496 doi "https://doi.org/10.1016/j.hpb.2018.02.067" @default.
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