Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements
Abstract
Background Objectives: Pancreatic cysts are frequently detected in high-risk individuals (HRI) undergoing surveillance for pancreatic cancer. The International Cancer of the Pancreas Screening (CAPS) Consortium developed consensus recommendations for surgical resection of pancreatic cysts in HRI that are similar to the Fukuoka guidelines used for the management of sporadic cysts. We compared the performance characteristics of CAPS criteria for pancreatic cyst management in HRI with the Fukuoka guidelines originally designed for the management of cysts in non-HRI.Methods Using prospectively collected data from CAPS studies, we determined for each patient with resected screen-detected cyst(s) whether Fukuoka guidelines or CAPS consensus statements would have recommended surgery. We compared sensitivity, specificity, PPV, NPV, and Receiver Operator Characteristics (ROC) curves of these guidelines at predicting the presence of high-grade dysplasia or invasive cancer in pancreatic cysts.Results 356/732 HRI had ≥ one pancreatic cyst detected; 24 had surgery for concerning cystic lesions. The sensitivity, specificity, PPV, and NPV for the Fukuoka criteria were 40%, 85%, 40%, and 85%, while those of the CAPS criteria were 60%, 85%, 50%, 89%, respectively. ROC curve analyses showed no significant difference between the Fukuoka and CAPS criteria.Conclusions In HRI, the CAPS and Fukuoka criteria are moderately specific, but not sufficiently sensitive for detecting advanced neoplasia in cystic lesions. New approaches are needed to guide the surgical management of cystic lesions in HRI.
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The five CAPS5 pancreatic resections for worrisome findings that harbored low-grade dysplasia only represent a smaller proportion of resections for low-grade lesions than reported in prior studies, likely due to better selection of patients for surgery.
“it is notable that these five cases represent a smaller proportion of resections for low-grade lesions than has been reported in prior studies14,15,29,30 and likely results from better selection of patients for surgery.”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [29]
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The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival
Dbouk, M., Katona, B. W., Brand, R. E., Chak, A., Syngal, S., Farrell, J. J., Kastrinos, F., Stoffel, E. M., Blackford, A. L., Rustgi, A. K., et al. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.22.00298 · Cited by 247 · see citing works
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- Authors
- Dbouk, M., Brewer Gutierrez, O. I., Lennon, A. M., Chuidian, M., Shin, E. J., Kamel, I. R., Fishman, E. K., He, J., Burkhart, R. A., Wolfgang, C. L., Hruban, R. H., Goggins, M. G., & Canto, M. I.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Canto, Marcia Irene
- ORCID
- Venue
- Pancreatology
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 21
- Issue
- 3
- Pages
- 613-621
- ISSN
- 1424-3903 (ISSN-L)
- OpenAlex
- W3126407300
- Cited by
- 46
- References
- 56
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 12 · 2023: 14 · 2022: 7 · 2021: 4
- FWCI
- 3.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pancreatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- pancreatic cysts, high-risk individuals, pancreatic cancer screening, surgical resection, high-grade dysplasia, diagnostic accuracy
- MeSH terms
- Pancreatic Intraductal Neoplasms, Adult, Aged, Carcinoma in Situ, Consensus Statements as Topic, Consensus Development Conferences as Topic, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pancreatic Cyst, Pancreatic Neoplasms, Retrospective Studies, Risk, Sensitivity and Specificity, Practice Guidelines as Topic, Early Detection of Cancer
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