Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results from a Large Multicenter Cohort Study

Phillip S. Ge, Srinivas Gaddam, Joseph W. Keach, Daniel Mullady, Norio Fukami, Steven A. Edmundowicz, Riad R. Azar, Raj J. Shah, Faris M. Murad, Vladimir M. Kushnir, Kourosh F. Ghassemi, Alireza Sedarat, Rabindra R. Watson, Stuart K. Amateau, Brian C. Brauer, Roy D. Yen, Lindsay Hosford, Thomas Hollander, Timothy R. Donahue, Richard D. SchulickBarish H. Edil, Martin D. McCarter, Csaba Gajdos, Augustin R. Attwell, V. Raman Muthusamy, Dayna S. Early, Sachin Wani

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. Methods We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. Results 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82). Conclusions This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalPancreas
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Multicenter Studies
Cohort Studies
Referral and Consultation
Pancreatic Cyst
Odds Ratio
Confidence Intervals
Fine Needle Biopsy
Multivariate Analysis
Mucins
Cell Biology
Weight Loss
Retrospective Studies
Communication
Demography

Keywords

  • CEA - carcinoembryonic antigen
  • endoscopic ultrasound
  • EUS - endoscopic ultrasound
  • FNA - fine-needle aspiration
  • intraductal papillary mucinous neoplasms
  • IPMN - intraductal papillary mucinous neoplasm
  • IQR - interquartile range
  • Key Words/Abbreviations
  • MCN - mucinous cystic neoplasm
  • mucinous cystic neoplasms
  • NMCN - nonmucinous cystic neoplasm
  • pancreatic cystic lesions
  • pancreatic cysts
  • PCL - pancreatic cystic lesion
  • SD - standard deviation
  • surgical predictors

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound : Results from a Large Multicenter Cohort Study. / Ge, Phillip S.; Gaddam, Srinivas; Keach, Joseph W.; Mullady, Daniel; Fukami, Norio; Edmundowicz, Steven A.; Azar, Riad R.; Shah, Raj J.; Murad, Faris M.; Kushnir, Vladimir M.; Ghassemi, Kourosh F.; Sedarat, Alireza; Watson, Rabindra R.; Amateau, Stuart K.; Brauer, Brian C.; Yen, Roy D.; Hosford, Lindsay; Hollander, Thomas; Donahue, Timothy R.; Schulick, Richard D.; Edil, Barish H.; McCarter, Martin D.; Gajdos, Csaba; Attwell, Augustin R.; Muthusamy, V. Raman; Early, Dayna S.; Wani, Sachin.

In: Pancreas, Vol. 45, No. 1, 01.01.2016, p. 51-57.

Research output: Contribution to journalArticle

Ge, PS, Gaddam, S, Keach, JW, Mullady, D, Fukami, N, Edmundowicz, SA, Azar, RR, Shah, RJ, Murad, FM, Kushnir, VM, Ghassemi, KF, Sedarat, A, Watson, RR, Amateau, SK, Brauer, BC, Yen, RD, Hosford, L, Hollander, T, Donahue, TR, Schulick, RD, Edil, BH, McCarter, MD, Gajdos, C, Attwell, AR, Muthusamy, VR, Early, DS & Wani, S 2016, 'Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results from a Large Multicenter Cohort Study', Pancreas, vol. 45, no. 1, pp. 51-57. https://doi.org/10.1097/MPA.0000000000000386
Ge, Phillip S. ; Gaddam, Srinivas ; Keach, Joseph W. ; Mullady, Daniel ; Fukami, Norio ; Edmundowicz, Steven A. ; Azar, Riad R. ; Shah, Raj J. ; Murad, Faris M. ; Kushnir, Vladimir M. ; Ghassemi, Kourosh F. ; Sedarat, Alireza ; Watson, Rabindra R. ; Amateau, Stuart K. ; Brauer, Brian C. ; Yen, Roy D. ; Hosford, Lindsay ; Hollander, Thomas ; Donahue, Timothy R. ; Schulick, Richard D. ; Edil, Barish H. ; McCarter, Martin D. ; Gajdos, Csaba ; Attwell, Augustin R. ; Muthusamy, V. Raman ; Early, Dayna S. ; Wani, Sachin. / Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound : Results from a Large Multicenter Cohort Study. In: Pancreas. 2016 ; Vol. 45, No. 1. pp. 51-57.
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abstract = "Objective Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. Methods We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. Results 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95{\%} confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95{\%} CI, 3.81-14.16), main duct communication (OR, 4.13; 95{\%} CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95{\%} CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95{\%} CI, 1.94-4.82). Conclusions This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.",
keywords = "CEA - carcinoembryonic antigen, endoscopic ultrasound, EUS - endoscopic ultrasound, FNA - fine-needle aspiration, intraductal papillary mucinous neoplasms, IPMN - intraductal papillary mucinous neoplasm, IQR - interquartile range, Key Words/Abbreviations, MCN - mucinous cystic neoplasm, mucinous cystic neoplasms, NMCN - nonmucinous cystic neoplasm, pancreatic cystic lesions, pancreatic cysts, PCL - pancreatic cystic lesion, SD - standard deviation, surgical predictors",
author = "Ge, {Phillip S.} and Srinivas Gaddam and Keach, {Joseph W.} and Daniel Mullady and Norio Fukami and Edmundowicz, {Steven A.} and Azar, {Riad R.} and Shah, {Raj J.} and Murad, {Faris M.} and Kushnir, {Vladimir M.} and Ghassemi, {Kourosh F.} and Alireza Sedarat and Watson, {Rabindra R.} and Amateau, {Stuart K.} and Brauer, {Brian C.} and Yen, {Roy D.} and Lindsay Hosford and Thomas Hollander and Donahue, {Timothy R.} and Schulick, {Richard D.} and Edil, {Barish H.} and McCarter, {Martin D.} and Csaba Gajdos and Attwell, {Augustin R.} and Muthusamy, {V. Raman} and Early, {Dayna S.} and Sachin Wani",
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TY - JOUR

T1 - Predictors for Surgical Referral in Patients with Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound

T2 - Results from a Large Multicenter Cohort Study

AU - Ge, Phillip S.

AU - Gaddam, Srinivas

AU - Keach, Joseph W.

AU - Mullady, Daniel

AU - Fukami, Norio

AU - Edmundowicz, Steven A.

AU - Azar, Riad R.

AU - Shah, Raj J.

AU - Murad, Faris M.

AU - Kushnir, Vladimir M.

AU - Ghassemi, Kourosh F.

AU - Sedarat, Alireza

AU - Watson, Rabindra R.

AU - Amateau, Stuart K.

AU - Brauer, Brian C.

AU - Yen, Roy D.

AU - Hosford, Lindsay

AU - Hollander, Thomas

AU - Donahue, Timothy R.

AU - Schulick, Richard D.

AU - Edil, Barish H.

AU - McCarter, Martin D.

AU - Gajdos, Csaba

AU - Attwell, Augustin R.

AU - Muthusamy, V. Raman

AU - Early, Dayna S.

AU - Wani, Sachin

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. Methods We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. Results 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82). Conclusions This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.

AB - Objective Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. Methods We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. Results 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82). Conclusions This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.

KW - CEA - carcinoembryonic antigen

KW - endoscopic ultrasound

KW - EUS - endoscopic ultrasound

KW - FNA - fine-needle aspiration

KW - intraductal papillary mucinous neoplasms

KW - IPMN - intraductal papillary mucinous neoplasm

KW - IQR - interquartile range

KW - Key Words/Abbreviations

KW - MCN - mucinous cystic neoplasm

KW - mucinous cystic neoplasms

KW - NMCN - nonmucinous cystic neoplasm

KW - pancreatic cystic lesions

KW - pancreatic cysts

KW - PCL - pancreatic cystic lesion

KW - SD - standard deviation

KW - surgical predictors

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U2 - 10.1097/MPA.0000000000000386

DO - 10.1097/MPA.0000000000000386

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VL - 45

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