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Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the long-term malignancy risk of incidental small pancreatic cysts.

Materials and methods

In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the “small pancreatic cyst” group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison “no cyst” group.

Results

The “small pancreatic cyst” group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the “no cyst” group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (p values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the “small pancreatic cyst” group, with a cancer rate of 0.9 (95% CI 0.1–3.1) cases per 1,000 patient-years. In the “no cyst” cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2–3.1) cases per 1,000 patient-years (p = 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (p = 0.09).

Conclusion

The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst.

Key Points

• After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts.

• Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.

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Abbreviations

CI:

Confidence interval

IPMN:

Intraductal papillary mucinous neoplasm

IQR:

Interquartile range

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Masoud Nakhaei, Mathew Bligh, Victoria Chernyak, Abraham F. Bezuidenhout, Alexander Brook & Olga R. Brook

  2. Department of Radiology, Montefiore, Bronx, NY, USA

    Victoria Chernyak

Authors
  1. Masoud Nakhaei
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  2. Mathew Bligh
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  3. Victoria Chernyak
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  4. Abraham F. Bezuidenhout
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  5. Alexander Brook
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  6. Olga R. Brook
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Corresponding author

Correspondence to Olga R. Brook.

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Guarantor

The scientific guarantor of this publication is Olga R. Brook.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Earlier results of two cohorts were previously reported in the following:

Brook OR, Beddy P, Pahade J, et al. Delayed growth in incidental pancreatic cysts: Are the current American College of Radiology recommendations for follow-up appropriate? Radiology; 2016;278(3):752–761.

Chernyak V, Flusberg M, Haramati LB, Rozenblit AM, Bellin E. Incidental pancreatic cystic lesions: is there a relationship with the development of pancreatic adenocarcinoma and all-cause mortality? Radiology. 2015;274(1):161–169.

This study demonstrates long-term follow-up on the same patients.

Methodology

• retrospective

• case-control study

• multicenter study

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Nakhaei, M., Bligh, M., Chernyak, V. et al. Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm. Eur Radiol 32, 3369–3376 (2022). https://doi.org/10.1007/s00330-021-08428-1

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  • DOI: https://doi.org/10.1007/s00330-021-08428-1

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