Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
BMJ Open Gastroenterol. 2020 Jul;7(1). doi: 10.1136/bmjgast-2020-000430.
Pancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.
We conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.
Within our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).
We found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.
胰腺囊性病变（PCLs）是一组具有不同恶性潜能的异质性病变。PCLs 常在影像学检查中偶然发现。对于没有立即进行切除或组织取样指征的患者，管理方法是进行影像学监测，以评估与恶性转化相关的特征。本研究旨在确定偶然发现的胰腺囊性病变患者对监测建议的依从率，并确定与依从性或失访相关的因素。
我们对一家三级安全网医院偶然发现无症状胰腺囊性病变的患者进行了单中心回顾性研究。随访定义为按照放射学报告建议进行重复成像。使用逻辑回归分析数据。
在我们的队列中（n=172），123 名（71.5%）患者完成了随访成像。接受胃肠病学就诊与完成胰腺囊性病变的随访最密切相关，并且在多变量逻辑回归模型中仍然具有统计学意义（p=0.001）。没有记录初级保健提供者的患者不太可能进行随访（p=0.028）。仅在单变量分析中，较大的囊肿大小与完成随访相关（p=0.067）。
我们发现，我们的大多数患者完成了偶然发现的胰腺囊性病变的随访。在我们的队列中，多达三分之一到四分之一的患者未完成胰腺囊性病变的随访。获得初级保健和利用专科胃肠病学护理与胰腺囊性病变的随访完成情况相关。如果得到验证，我们的研究结果可以为改善胰腺囊性病变的随访率提供潜在的干预措施。
