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Duvvuri A, Bandla H, Thoguluva VC, Dasari C, Desai M, Nutalapati V, Moole V, Anvesh N, Harsh P, Gress F, Sharma P, Kohli DR. Comparing accuracy of high-risk features for detecting advanced neoplasia in pancreatic cystic lesions: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34:743-750. [PMID: 34475747 PMCID: PMC8375658 DOI: 10.20524/aog.2021.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background The American Gastroenterological Association recommends endoscopic ultrasound (EUS) for evaluating pancreatic cystic lesions (PCL) with ≥2 high-risk features (HRF), whereas the American College of Gastroenterology recommends EUS for ≥1 HRF. This systematic review and meta-analysis compared the diagnostic accuracy of using ≥1 vs. ≥2 HRF for assessing the risk of advanced neoplasia (AN) and performing EUS in PCL. Methods An electronic database search was performed for eligible studies. AN was defined as pancreatic adenocarcinoma, intraductal papillary mucinous neoplasm or mucinous cystadenoma with high-grade dysplasia, pancreatic intraepithelial neoplasia and pancreatic neuroendocrine tumors. HRF included cyst size ≥3 cm, solid component, and dilated pancreatic duct ≥5 mm. The primary outcome was the sensitivity and specificity of using ≥1 vs. ≥2 HRF as an indication for EUS to detect AN in PCL. Results Of 38 studies initially screened, 8 were included in the final analysis. Seven studies assessed the accuracy of ≥2 HRF and 4 studies assessed ≥1 HRF. The pooled sensitivity, specificity, positive and negative predictive values of EUS for detecting AN were 41.7% (95% confidence interval 19.5-67.8%), 90.8% (81.9-95.5%), 30.4% (19.4-44.2%) and 94.3% (89.6-97.0%) with ≥2HRFs, and 77.1% (66.1-85.3%), 72.7% (50.4-87.5%), 17.95% (10.3-29.4%), 98.1% (90.8-99.6%), respectively, with ≥1 HRF. Conclusion Performing EUS for PCL with ≥1 HRF could offer greater sensitivity in detecting AN compared to ≥2 HRF, with a similar negative predictive value.
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Affiliation(s)
- Abhiram Duvvuri
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli).,Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Madhav Desai, Venkat Nutalapati, Patel Harsh)
| | - Harikrishna Bandla
- Saint Peter's University Hospitals, New Brunswick, NJ (Harikrishna Bandla)
| | - Vivek Chandrasekar Thoguluva
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli).,Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Madhav Desai, Venkat Nutalapati, Patel Harsh)
| | - Chandra Dasari
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli)
| | - Madhav Desai
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli).,Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Madhav Desai, Venkat Nutalapati, Patel Harsh)
| | - Venkat Nutalapati
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli).,Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Madhav Desai, Venkat Nutalapati, Patel Harsh)
| | - Vishnu Moole
- University of Illinois College of Medicine, Peoria, IL (Vishnu Moole)
| | - Narimiti Anvesh
- Saint Vincent Hospital, Worcester, MA (Narimiti Anvesh), USA
| | - Patel Harsh
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Madhav Desai, Venkat Nutalapati, Patel Harsh)
| | - Frank Gress
- Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY (Frank Gress)
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli)
| | - Divyanshoo Rai Kohli
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO (Abhiram Duvvuri, Vivek Chandrasekar Thoguluva, Chandra Dasari, Madhav Desai, Venkat Nutalapati, Prateek Sharma, Divyanshoo Rai Kohli)
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Kohli DR, Smith KR, Wong J, Yu Z, Boucher K, Faigel DO, Pannala R, Burt RW, Curtin K, Samadder NJ. Familial pancreatic cancer risk: a population-based study in Utah. J Gastroenterol 2019; 54:1106-1112. [PMID: 31240435 DOI: 10.1007/s00535-019-01597-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/03/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pancreas adenocarcinoma (PC) has an undefined hereditary component. We quantified the familial risk of PC among relatives of patients diagnosed with PC and stratified it based on anatomic location of PC and age and sex of the proband. METHODS This is a retrospective, population-based, case-control study of PC diagnosed in Utah between 1980 and 2011. The Utah population database and cancer registry were used to identify index patients with PC. The risk of PC in first-degree relatives (FDRs), second-degree relatives (SDRs), and first cousins (FCs) of probands was compared with randomly selected sex- and age-matched population controls. RESULTS A total of 4,095 patients and 40,933 controls were identified. The relative risk (RR) of PC was 1.76 (95% CI 1.35-2.29) in FDRs, 1.42 (95% CI 1.18-1.7) in SDRs and 1.08 (95% CI 0.95-1.23) in FCs of probands compared to relatives of PC-free controls. The RR were elevated in FDRs (1.96, 95% CI 1.45-2.65), SDRs (1.54, 95% CI 1.19-1.98) and FCs (1.18, 95% CI 1.0-1.64) of female probands. Among probands diagnosed as < 65 years, RR was 2.12 (95% CI 1.37-3.28) in FDRs, 1.94 (95% CI 1.44-2.62) in SDRs, and 1.28 (95% CI 1.0-1.64) in FCs. Overall, the RR for PC was elevated in FDRs regardless of the anatomic location of PC. DISCUSSION There is an increased risk of PC in FDR and more distant relatives of patients with PC. Relatives of female patients with PC and patients diagnosed at age < 65 years are at a significantly increased risk of PC.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.,Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, MO, USA
| | - Ken Robert Smith
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jathine Wong
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Zhe Yu
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Kenneth Boucher
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Randall W Burt
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Karen Curtin
- Department of Medicine (Gastroenterology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Medicine (Genetic Epidemiology), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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