| Title |
New guidelines for use of endoscopic ultrasound for evaluation and risk stratification of pancreatic cystic lesions may be too conservative
|
|---|---|
| Published in |
Surgical Endoscopy, December 2017
|
| DOI | 10.1007/s00464-017-5941-y |
| Pubmed ID | |
| Authors |
Nadav Sahar, Anthony Razzak, Zaheer S. Kanji, David L. Coy, Richard Kozarek, Andrew S. Ross, Michael Gluck, Michael Larsen, Shayan Irani, S. Ian Gan |
| Abstract |
The role of EUS in managing asymptomatic pancreatic cystic lesions (PCLs) remains unresolved. We retrospectively evaluated EUS in risk stratification of PCLs when adhering to the most recent AGA guidelines. Asymptomatic PCLs that were evaluated by EUS from January 2014 to December 2014 were retrospectively reviewed including associated cytology, fluid analysis, and relevant surgical pathology. Cross-sectional imaging reports were reviewed blindly by an expert radiologist using AGA risk stratification terminology. Accepted imaging high-risk features (HRF) included cyst diameter > 3 cm, dilated upstream pancreatic ducts, and a solid component in the cyst. We reviewed 125 patients who underwent EUS. Expert review of cross-sectional imaging resulted in a different interpretation 25% of the time including 1 malignant cyst. Ninety-three patients (75%) had no HRFs on cross-sectional imaging; 28 patients (22%) were diagnosed with 1 HRF and 4 patients (3%) had 2 HRFs. Adhering to AGA guidelines using 2 HRF as threshold for use of EUS, the diagnosis of malignant and high-risk premalignant lesions (including pancreatic adenocarcinoma, mucinous cystadenoma, neuroendocrine tumors, and IPMN with dysplasia) had a 40% sensitivity and 100% specificity. Had EUS been utilized based on a threshold of 1 HRF on imaging, malignant and high-risk premalignant lesions would have been identified with 80% sensitivity and 95% specificity. By adding EUS to radiographic imaging, the specificity for detecting carcinomas (p = 0.0009) and detection of all premalignant lesions (p = 0.003) statistically improved. Furthermore, EUS allowed 14 patients (11%) to avoid further surveillance by lowering their risk stratification. EUS remains an essential risk stratification modality for incidental PCLs. Current guideline suggestions of its utility may be too stringent. Our study justifies expert radiology review when managing PCLs. Further studies are required to identify the optimal approach to PCL management. |
X Demographics
The data shown below were collected from the profiles of 15 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 2 | 13% |
| Colombia | 2 | 13% |
| United Kingdom | 1 | 7% |
| Mexico | 1 | 7% |
| Venezuela, Bolivarian Republic of | 1 | 7% |
| Italy | 1 | 7% |
| South Africa | 1 | 7% |
| Unknown | 6 | 40% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 13 | 87% |
| Science communicators (journalists, bloggers, editors) | 1 | 7% |
| Practitioners (doctors, other healthcare professionals) | 1 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 28 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 28 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 7 | 25% |
| Researcher | 4 | 14% |
| Student > Postgraduate | 4 | 14% |
| Student > Ph. D. Student | 3 | 11% |
| Student > Doctoral Student | 2 | 7% |
| Other | 5 | 18% |
| Unknown | 3 | 11% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 15 | 54% |
| Neuroscience | 2 | 7% |
| Biochemistry, Genetics and Molecular Biology | 1 | 4% |
| Social Sciences | 1 | 4% |
| Psychology | 1 | 4% |
| Other | 2 | 7% |
| Unknown | 6 | 21% |
Attention Score in Context
This research output has an Altmetric Attention Score of 10. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 April 2018.
All research outputs
#3,197,473
of 23,015,156 outputs
Outputs from Surgical Endoscopy
#443
of 6,103 outputs
Outputs of similar age
#73,830
of 441,864 outputs
Outputs of similar age from Surgical Endoscopy
#25
of 142 outputs
Altmetric has tracked 23,015,156 research outputs across all sources so far. Compared to these this one has done well and is in the 86th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,103 research outputs from this source. They receive a mean Attention Score of 4.1. This one has done particularly well, scoring higher than 92% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 441,864 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 83% of its contemporaries.
We're also able to compare this research output to 142 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 82% of its contemporaries.