ABSTRACT Objectives: Pancreatic cystic lesions (PCL) without “worrisome features” (WF) at the diagnosis, necessitate a lifetime surveillance to monitor cysts size, pancreatic main duct dilatation or mural nodules. Follow-up is nowday usually performed with a MRI; nevertheless, these parameters can also be evaluated with an ultrasound (US) scan. The purpose of this study is to estimate the safety, the feasibility and the economic impact of an abdominal US scan for the follow-up of PCL, with a delayed use of MRI. Materials and Methods: We conducted a retrospective analysis of all patients underwent an abdominal US scan as follow-up for “low risk” PCL in our institution. US scan was performed every six months for the first year and then, in case of stability of the disease, annually from the second to the fifth year. MRI scan was routinely performed every two years, or in presence of considerable modifications at US. We compared the two imaging modalities in terms of sensitivity and specificity in identifying cysts variations. We also performed a costs-analysis between the theoretical application of the international guidelines and our follow-up strategy with abdominal US scan and delayed MRI. Results: Between January 2012 and January 2016, we followed-up with abdominal US scan two hundred patients with PCL; 138 out of 200 (69%) were females, whereas 62 (31%) were males. Mean follow-up period was 25.1 months (±18.2). Two patients (1%) needed surgery for the appearance of WF at both imaging, with concordance among US and MRI. During the follow-up, US scan identificated “low grade” modifications in 28 patients (14%), included main pancreatic duct dilatation <6 mm and increasing of the main cyst of about 0.5 cm. All of these modifications were confirmed at MRI scan, without adding more prognostic details. In only 11 cases (5.5%) a routine MRI identified an evolution of the lesions not showed at US, but only related to an increased number of the PCL (p=0.14). Nevertheless, a MRI every 6 months would not have changed the decisional strategy. According to the theoretical application of international guidelines with MRI follow-up, the mean cost of surveillance should have been 402±273.7 € per patient, while it decreases to 215.4±212.6 € with our follow-up strategy (p< 0.0001). Conclusion: Abdominal US scan in patients with PCL without WF could be considered a valid and safe alternative to MRI, reducing the numbers of II level examinations and therefore reducing costs. Long term safety of this approach need to be validated on a longer follow-up period, with a larger series of patients and prospective studies.
PANCREATIC CYSTIC LESIONS IN FOLLOW-UP: COULD ABDOMINAL ULTRASOUND SCAN REPRESENT A SAFE AND COST-SAVING ALTERNATIVE TO MRI?
Guadagni S;Pisano R;Palmeri M;Di Franco G;Furbetta N;Gianardi D;Bianchini M;Rossi L;Stefanini G;Gambaccini D;Marchi S;Funel N;CAMPATELLI, ALBERTO;Mosca F;Di Candio G;Morelli L
2018-01-01
Abstract
ABSTRACT Objectives: Pancreatic cystic lesions (PCL) without “worrisome features” (WF) at the diagnosis, necessitate a lifetime surveillance to monitor cysts size, pancreatic main duct dilatation or mural nodules. Follow-up is nowday usually performed with a MRI; nevertheless, these parameters can also be evaluated with an ultrasound (US) scan. The purpose of this study is to estimate the safety, the feasibility and the economic impact of an abdominal US scan for the follow-up of PCL, with a delayed use of MRI. Materials and Methods: We conducted a retrospective analysis of all patients underwent an abdominal US scan as follow-up for “low risk” PCL in our institution. US scan was performed every six months for the first year and then, in case of stability of the disease, annually from the second to the fifth year. MRI scan was routinely performed every two years, or in presence of considerable modifications at US. We compared the two imaging modalities in terms of sensitivity and specificity in identifying cysts variations. We also performed a costs-analysis between the theoretical application of the international guidelines and our follow-up strategy with abdominal US scan and delayed MRI. Results: Between January 2012 and January 2016, we followed-up with abdominal US scan two hundred patients with PCL; 138 out of 200 (69%) were females, whereas 62 (31%) were males. Mean follow-up period was 25.1 months (±18.2). Two patients (1%) needed surgery for the appearance of WF at both imaging, with concordance among US and MRI. During the follow-up, US scan identificated “low grade” modifications in 28 patients (14%), included main pancreatic duct dilatation <6 mm and increasing of the main cyst of about 0.5 cm. All of these modifications were confirmed at MRI scan, without adding more prognostic details. In only 11 cases (5.5%) a routine MRI identified an evolution of the lesions not showed at US, but only related to an increased number of the PCL (p=0.14). Nevertheless, a MRI every 6 months would not have changed the decisional strategy. According to the theoretical application of international guidelines with MRI follow-up, the mean cost of surveillance should have been 402±273.7 € per patient, while it decreases to 215.4±212.6 € with our follow-up strategy (p< 0.0001). Conclusion: Abdominal US scan in patients with PCL without WF could be considered a valid and safe alternative to MRI, reducing the numbers of II level examinations and therefore reducing costs. Long term safety of this approach need to be validated on a longer follow-up period, with a larger series of patients and prospective studies.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
