Lee Alexander, Kadiyala Vivek, Lee Linda S
Texas Digestive Disease Consultants, Dallas, Texas, United States.
Brigham and Women's Hospital, Division of Gastroenteriology, Hepatology, and Endoscopy, Boston, Massachusetts, United States.
Endosc Int Open. 2017 Feb;5(2):E116-E122. doi: 10.1055/s-0042-118703.
Management of asymptomatic pancreatic cysts is challenging. Guidelines by the American Gastroenterological Association (AGA) and International Association of Pancreatology (Fukuoka) seek to identify high-risk patients. We assessed performance of these guidelines in selecting patients for endoscopic ultrasound (EUS) and/or surgery. PART I - We retrospectively studied 143 asymptomatic cysts with magnetic resonance imaging (MRI) followed by EUS. Appropriate selection for EUS was defined as: malignant cytology or surgical pathology, or development of concerning features on MRI as defined by the guidelines. PART II - We retrospectively studied 152 resected cysts to assess the performance of guidelines in selecting cysts for surgery using malignant histology as the outcome. PART I - Of 143 EUS, 43 (30.1 %) were male with median age 65.0 years (interquartile range [IQR] 58.0 - 73.0). AGA guideline demonstrated lower sensitivity (17.6 % versus 35.3 %, = 0.03), higher specificity (94.5 % versus 66.1 %, p < 0.001), and higher accuracy (76.2 % versus 58.7 %, = 0.002) than Fukuoka. There was no difference in positive predictive value (50.0 % versus 24.5 %, = 0.15) and negative predictive value (78.6 % versus 76.6 %, p=0.75). PART II - Of 152 resected cysts, 45 (29.8 %) were male with median age 59.0 years (IQR 47.3 - 66.7). There was no difference in performance characteristics of the guidelines in selecting cysts for surgery. AGA and Fukuoka guidelines missed 25.0 % and 18.8 % of malignant cysts, respectively ( = 1.00). For referral to EUS, the AGA guideline was highly specific compared to Fukuoka; both suffered from poor sensitivity, although the Fukuoka guideline was relatively more sensitive than AGA. For referral to surgery, both guidelines have modest sensitivity and specificity and miss a similar percentage of malignant lesions.
无症状胰腺囊肿的管理具有挑战性。美国胃肠病学会（AGA）和国际胰腺病协会（福冈）发布的指南旨在识别高危患者。我们评估了这些指南在选择接受内镜超声（EUS）检查和/或手术的患者方面的表现。第一部分——我们对143例无症状囊肿患者进行了回顾性研究，这些患者先接受磁共振成像（MRI）检查，随后接受EUS检查。EUS的适当选择定义为：恶性细胞学检查或手术病理检查结果，或MRI出现指南所定义的可疑特征。第二部分——我们对152例已切除的囊肿进行了回顾性研究，以评估指南在以恶性组织学结果为标准选择手术囊肿方面的表现。第一部分——在143例接受EUS检查的患者中，43例（30.1%）为男性，中位年龄65.0岁（四分位间距[IQR]为58.0 - 73.0）。与福冈指南相比，AGA指南的敏感性较低（17.6%对35.3%，P = 0.03），特异性较高（94.5%对66.1%，P < 0.001），准确性也较高（76.2%对58.7%，P = 0.002）。阳性预测值（50.0%对24.5%，P = 0.15）和阴性预测值（78.6%对76.6%，P = 0.75）没有差异。第二部分——在152例已切除的囊肿中，45例（29.8%）为男性，中位年龄59.0岁（IQR为47.3 - 66.7）。在选择手术囊肿方面，指南的表现特征没有差异。AGA和福冈指南分别漏诊了25.0%和18.8%的恶性囊肿（P = 1.00）。对于推荐进行EUS检查，与福冈指南相比，AGA指南具有较高的特异性；两者的敏感性都较差，尽管福冈指南相对AGA指南更敏感一些。对于推荐进行手术，两个指南的敏感性和特异性都一般，且漏诊恶性病变的比例相似。
