The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines

Robert J. Schenck*, Frank H Miller, Rajesh N Keswani

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives We aimed to determine incidental pancreatic cyst ("cyst") surveillance patterns, predictors of receiving surveillance, and guideline adherence. Methods We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010-2011). All follow-up care was abstracted over a 5-year period. Results Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9-119) and recommending follow-up (OR, 5.5; 95% CI, 2.1-13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3-89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1-10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline. Conclusions Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.

Original languageEnglish (US)
Pages (from-to)883-887
Number of pages5
JournalPancreas
Volume48
Issue number7
DOIs
StatePublished - Aug 1 2019

Fingerprint

Pancreatic Cyst
Cysts
Guidelines
Odds Ratio
Confidence Intervals
Guideline Adherence
Aftercare
Radiology
Tertiary Care Centers
Dilatation
Pancreas
Cohort Studies
Retrospective Studies

Keywords

  • incidental
  • intraductal papillary mucinous neoplasm
  • pancreas
  • pancreatic cancer
  • pancreatic cyst
  • pancreatic mass

ASJC Scopus subject areas

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

Cite this

@article{53ebc5d65d9a4565bd07e9aebad4b375,
title = "The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines",
abstract = "Objectives We aimed to determine incidental pancreatic cyst ({"}cyst{"}) surveillance patterns, predictors of receiving surveillance, and guideline adherence. Methods We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010-2011). All follow-up care was abstracted over a 5-year period. Results Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53{\%}) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95{\%} confidence interval [CI], 1.9-119) and recommending follow-up (OR, 5.5; 95{\%} CI, 2.1-13.9), pancreas main duct dilation (OR, 10.7; 95{\%} CI, 1.3-89), and absence of multiple cysts (OR, 2.5; 95{\%} CI, 1.1-10.0). Of the 47 patients who received surveillance, 66{\%} met minimum surveillance imaging intervals of at least one guideline. Conversely, 21{\%} of patients met the criteria for overutilization in at least one guideline. Conclusions Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.",
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The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines. / Schenck, Robert J.; Miller, Frank H; Keswani, Rajesh N.

In: Pancreas, Vol. 48, No. 7, 01.08.2019, p. 883-887.

Research output: Contribution to journalArticle

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N2 - Objectives We aimed to determine incidental pancreatic cyst ("cyst") surveillance patterns, predictors of receiving surveillance, and guideline adherence. Methods We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010-2011). All follow-up care was abstracted over a 5-year period. Results Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9-119) and recommending follow-up (OR, 5.5; 95% CI, 2.1-13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3-89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1-10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline. Conclusions Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.

AB - Objectives We aimed to determine incidental pancreatic cyst ("cyst") surveillance patterns, predictors of receiving surveillance, and guideline adherence. Methods We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010-2011). All follow-up care was abstracted over a 5-year period. Results Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9-119) and recommending follow-up (OR, 5.5; 95% CI, 2.1-13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3-89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1-10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline. Conclusions Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.

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