University of British Columbia, 2329, West Mall, Vancouver, BC, V6T 1Z4, Canada.
Am J Surg. 2021 Apr;221(4):813-818. doi: 10.1016/j.amjsurg.2020.03.036. Epub 2020 Apr 18.
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.
由于 CT 和 MRI 的广泛应用，胰腺囊性肿瘤（PCN）的检出率逐渐增高。EUS 是一种新兴的工具，可以区分胰腺囊肿的良恶性特征。我们希望确定需要 EUS 检查的特定影像学表现和患者特征。
我们进行了一项回顾性病例对照图表审查，评估了 2010 年 1 月 1 日至 2017 年 12 月 31 日期间诊断为胰腺囊肿并接受 EUS 检查的患者。
当 CT 成像发现囊肿大小>4cm（OR=4.07，p<0.01）、囊肿大小>3cm（OR=3.79，p<0.001）和囊肿伴有实性成分时，EUS 改变了治疗方案。此外，患者特征，包括年龄<50 岁、男性和 10 包年吸烟史，与 EUS 治疗方案的改变显著相关。
我们的研究结果表明，EUS 检查应根据特定 HRF 的发现来协调，同时考虑高危患者特征，而不是按照现有指南建议的累积多个 HRF。
