P1716 - Long-term Surveillance of Pancreatic Cysts Can Detect Cancer Early, but Better Predictors Are Needed

Abraham Yu, MD¹, Ikenna K. Emelogu, MD², Martin Coronel, MD³, Emmanuel Coronel, MD³, Phillip S. Ge, MD³, Brian R. Weston, MD³, Manoop Bhutani, MD³, William Ross, MD, MSCE³, Shria Kumar, MD³, Jeffrey Lee, MD, MPH^3
1University of Texas Health Science Center at Houston, Houston, TX; ²Baylor College of Medicine, Houston, TX; ³University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Pancreatic cyst surveillance poses a dilemma for patients and physicians alike. In particular, the utility of extended surveillance past five years remains unclear. The decision to proceed with surveillance is often based on factors such as the patient’s potential surgical status and cyst characteristics. There is limited consensus on the outcomes of longer-term surveillance. We describe post-five-year surveillance outcomes at our tertiary care, cancer focused center.

Methods: We identified patients who underwent an endoscopic ultrasound (EUS) exam for pancreatic cyst surveillance between 3/1/2007-9/1/2015. Patients were included if they did not have a detected neoplasm or undergo pancreatic surgery during their initial 5-year surveillance period, and if they continued surveillance after 5 years via imaging and/or EUS for dedicated cyst surveillance. We report cyst characteristics, patient demographics, diagnostic studies, and outcomes through 9/1/2020.

Results: We identify 60 patients who met inclusion criteria, median age 66 years (IQR 58-72) and 37 (62%) male. The majority, 47 (78%), denied any family history of pancreatic cancer. Forty-one (68%) had pancreatic cyst incidentally detected on imaging. Other studies were done for indications including abdominal pain, pancreatitis, diarrhea, and weight loss.

Table 1 demonstrates initial EUS characteristics of the pancreatic cysts. Total median follow-up time was 8.4 years (IQR 7.4-9.0). Patients underwent median of 7 imaging studies (IQR 6-9) and 1 EUS (IQR 1-2) for dedicated cyst surveillance in total.

In our cohort of 60 patients, one (1.7%) was found to have pancreatic ductal adenocarcinoma (PDAC). A 1.3 cm lesion was incidentally detected at age 68, and EUS-FNA revealed no malignant cells. The patient subsequently underwent surveillance for 8.3 years, with 3 EUS exams and 9 imaging studies for dedicated cyst evaluation, without significant changes in cyst characteristics. The patient was eventually found to have a locally advanced PDAC on surveillance. No other patients were found to have dysplastic or cancerous lesions, and none underwent pre-emptive surgery.

Discussion: The utility of long-term surveillance of pancreatic cysts remains unknown. Here, we demonstrate that malignant transformation is rare, but that long-term surveillance may detect early pancreatic cancer. Better predictors are needed to guide which patients may benefit most from long-term surveillance.



Disclosures:


Abraham Yu, MD¹, Ikenna K. Emelogu, MD², Martin Coronel, MD³, Emmanuel Coronel, MD³, Phillip S. Ge, MD³, Brian R. Weston, MD³, Manoop Bhutani, MD³, William Ross, MD, MSCE³, Shria Kumar, MD³, Jeffrey Lee, MD, MPH³. P1716 - Long-term Surveillance of Pancreatic Cysts Can Detect Cancer Early, but Better Predictors Are Needed, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.