. THE ROLE OF ABDOMINAL ULTRASOUND SCAN FOR THE FOLLOW-UP OF PANCREATIC CYSTIC LESIONS: A COST- SAVING AND SAFE ALTERNATIVE TO THE ROUTINE USE OF MRI?

Background: Patients with pancreatic cystic neoplasms (PCN) without absolute or relative surgical criteria at the time of diagnosis, usually necessitate a lifetime surveillance. We herein report on our clinical experience regard the safety, feasibility and economic impact of an abdominal ultrasound (US) follow-up strategy, with a delayed use of the gold standard Magnetic Resolution Imaging (MRI). Method: We retrospectively evaluated the records of all the patients who had been followed with an abdominal US for the presence of non-surgical PCN at the time of diagnosis, in our institution. All of patients underwent to a US every six months for the first year and then, annually. A MRI scan was routinely executed, every two years, or anticipated in the presence of considerable modifications at US. Results: In the 5 years’ period, two-hundred patients entered in our US follow-up program. Mean follow-up period was 25.1 months (±18.2). In only 11 patients (5.5%) a routine MRI identified evolution of the lesions not showed at US, but mainly related to an expected increased number of the PCN (p=0.14). The overall mean cost of surveillance, in a theoretical application of the european evidenced-based guidelines with MRI at our group of patients, would have been 1158.9±798.6 €, while according to our follow-up strategy it was 366.4±348.7 € (p< 0.0001). Conclusion: In patients with PCN without absolute or relative surgical criteria at the time of diagnosis, abdominal US scan, could be a safe alternative to MRI, reducing the numbers of II level examinations and therefore the costs.