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Determining when endoscopic ultrasound changes management for patients with pancreatic cystic neoplasms.

Authors
  • Sidhu, Hasrit1
  • Maher, Safia2
  • Bleszynski, Michael S3
  • Chen, Leo4
  • Farnell, Dave5
  • Gan, Ian6
  • Segedi, Maja7
  • 1 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 2 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 3 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 4 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 5 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 6 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
  • 7 University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada. Electronic address: [email protected] , (Canada)
Type
Published Article
Journal
American journal of surgery
Publication Date
Apr 01, 2021
Volume
221
Issue
4
Pages
813–818
Identifiers
DOI: 10.1016/j.amjsurg.2020.03.036
PMID: 32334802
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to increased CT and MRI usage. EUS is an emerging tool that can differentiate between benign and malignant features of pancreatic cysts. We hoped to identify the specific cross-sectional imaging findings and patient characteristics that warrant EUS referral. We conducted a retrospective case-control chart review, evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS between January 1, 2010 and December 31, 2017. EUS was found to change management when CT imaging found cyst size > 4 cm (OR = 4.07, p < 0.01), cyst size > 3 cm (OR = 3.79, p < 0.001) and associated solid component to the cyst (OR = 5.95, p < 0.01). Additionally, patient characteristics, including age less than 50 years, male sex and 10-pack year smoking history were significantly associated with EUS change in management. Our findings suggest that EUS referral should be coordinated based on the findings of specific HRFs, with support from high risk patient characteristics, rather than the accumulation of multiple HRFs, as suggested by existing guidelines. Copyright © 2020 Elsevier Inc. All rights reserved.

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