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Initial Management and Radiologic Surveillance of Incidental Pancreatic Cysts Audit
Poster Title: Initial Management and Radiologic Surveillance of Incidental Pancreatic Cysts Audit
Submitted on 26 Sep 2019
Author(s): Dr Rezwan F A Ahmed
Affiliations: King's College Hospitals NHS Foundation Trust
Poster Views: 56
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Poster Information
Abstract: Pancreatic cysts are mainly incidental findings and are increasingly being Diagnosed. This can be explained by the increasing number of abdominal imaging and advances in imaging technology. Neoplastic cysts are recognised as the majority of these incidental cysts; furthermore, few variants have malignant potentials and can harbour high-grade dysplastic cells. Therefore, the dilemma is whether to perform surgical resection or arrange timely radiologic surveillance.
Unfortunately, we are lacking national UK guidelines for the management of incidental pancreatic cysts. This can make management of such cysts across the UK inconsistent and disorganised. On the other hand, American Gastroenterological Association has published their own guidelines which have been accepted internationally to varying degrees.
In this audit, we have reviewed all of the abdominal scans which detected pancreatic cyst in three hospitals of the same NHS trust over a period of one year. We examined the initial management approach. The data was compared against the AGA guidelines. A total of 92 patients were found to have cysts. After dividing the patients into different groups according to presence of high-risk features on imaging.
We noticed that a significant number of patients without high-risk imaging features had actually being reviewed in MDT meetings, while others did not have follow up scans arranged. This group might have been under-scanned and over-referred to MDT meetings. All of the patients with two or more high-risk imaging features had MDT review and follow up scans. Equally reassuring, no pancreatic malignancy was missed among the population.
Summary: It is recognized that pancreatic cysts are increasingly being diagnosed due to advances in imaging technology and increasing number of scans. However we are lacking national/local guidelines to manage them. In conclusion, we can see that a significant number of patients without high-risk features were reviewed in MDT; while others have not been followed up with scan at one-year interval. Furthermore, all of the patients with 2 or more high-risk features received MDT review and timely re-scan.References: 1. Karen S L, Aarti S, Nell M R, et al. Prevalence of Incidental Pancreatic Cysts in the Adult Population on MR Imaging. American Journal of Gastroenterology 2010; 105:2079–2084.
2. Ye R C, Joo K P, Jin-Young J, et al. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals. Medicine 2016;95:51
3. David A K, Kaye M R, Stuart R G, et al. The Clinical Relevance of the Increasing Incidence of Intraductal Papillary Mucinous Neoplasm. Clinical Gastroenterology and Hepatology 2012;10(5): 555–558.
4. Maria M, Mellena D B, Robert A P, et al. Association Between Advances in High-Resolution Cross-Section Imaging Technologies and Increase in Prevalence of Pancreatic Cysts From 2005 to 2014. Clinical Gastroenterology and Hepatology 2016;14:585–593
5. James M S, Joo H H, Paul M. American Gastroenterological Association Technical Review on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts. Gastroenterology 2015;148:824
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