P3485 - A Systematic Approach to Pancreatic Cysts: An Investigation of the Impact of Standardized Radiology Report Templates on the Management of New Pancreatic Cysts
Columbia University Irving Medical Center New York, NY
Mahip Grewal, MD1, Chenchan Huang, MD2, Emil Agarunov, BS3, Lauren Khanna, MD2, Gregory B. Haber, MD2, Eileen Janec, MD2, Christopher Wolfgang, MD, PhD2, Tamas A.. Gonda, MD2 1Columbia University Irving Medical Center, New York, NY; 2NYU Grossman School of Medicine, New York, NY; 3NYU Langone Health, New York, NY
Introduction: More frequent abdominal imaging has led to increased incidental detection of pancreatic cystic neoplasms (PCNs). In November 2021, a consensus group of physicians established Institutional Guidelines for PCN management at a large academic health system. Along with imaging, these guidelines recommend biomarker (Ca19-9, HbA1c) surveillance (Figure 1). The Institutional Guidelines were established to implement standardized radiology report templates with follow-up recommendations to be included in all MRI scans identifying PCNs. The purpose of this study was to assess the impact of these templates on the management of new PCNs.
Methods: The consensus group receives monthly secure lists of medical record numbers for patients who had MRIs identifying new PCNs. The post-implementation cohort was drawn from the November 2021-April 2022 lists. The pre-implementation period was defined as 2018-2019. 3 categories of cysts were assessed: 1-2 cm cysts, 2-3cm cysts, and cysts with worrisome features. Rates of initial follow-up of any kind for new PCNs, as well as concordance with the 2018 American College of Gastroenterology (ACG), 2017 International Association of Pancreatology (IAP), and 2021 Institutional Guidelines, were compared pre- and post-implementation. Manual chart review was conducted to 1) verify whether a PCN was truly new, 2) exclude patients with non-neoplastic cysts, concomitant malignancy, or other indications for routine abdominal imaging, and 3) tabulate dates of first EUS and/or MRI and biomarker blood draws. Chi Square Tests and T-Tests were used for statistical analyses.
Results: Rates of follow-up of any kind were similar between the cohorts. For both cohorts, concordance with all three guidelines was highest among cysts with worrisome features. For 2-3cm cysts and cysts with worrisome features, there was an increase in IAP guideline concordance post-implementation. For 2-3cm cysts, the rate of biomarker surveillance increased from 3% pre-implementation to 32% post-implementation (p=0.006). Mean time to first EUS or MRI was shorter post-implementation for all cyst categories (Table 1).
Discussion: These early findings suggest that standardized templates could promote shorter time to first follow-up imaging and higher rates of biomarker surveillance for new PCNs. Nonetheless, comparative analyses of larger cohorts will be required to confirm whether the standardized templates significantly improve guideline adherence.
Figure: Figure 1. Guideline Recommendations for Initial Follow-up of New Pancreatic Cysts
*These internal guidelines were established by a consensus group of gastroenterologists, hepato-pancreato-biliary surgeons, radiologists, and pathologists at a large academic hospital. The guidelines were associated with the standardized templates that have been included in all radiology reports identifying pancreatic cysts since November 2021 across the health system.
Note: Worrisome features include cyst size > 3 cm, thickened/enhancing cyst wall, main duct size 5-9 mm, enhancing mural nodule < 5 mm, abrupt change in main pancreatic duct caliber with distal atrophy, or rapid cyst growth rate > 5 mm over 2 years.2
1. Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG clinical guideline: Diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113(4):464-479. doi:10.1038/ajg.2018.14 2. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738-753. doi:10.1016/j.pan.2017.07.007
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Mahip Grewal indicated no relevant financial relationships.
Chenchan Huang indicated no relevant financial relationships.
Emil Agarunov indicated no relevant financial relationships.
Lauren Khanna indicated no relevant financial relationships.
Gregory Haber indicated no relevant financial relationships.
Eileen Janec indicated no relevant financial relationships.
Christopher Wolfgang indicated no relevant financial relationships.
Tamas Gonda indicated no relevant financial relationships.
Mahip Grewal, MD1, Chenchan Huang, MD2, Emil Agarunov, BS3, Lauren Khanna, MD2, Gregory B. Haber, MD2, Eileen Janec, MD2, Christopher Wolfgang, MD, PhD2, Tamas A.. Gonda, MD2. P3485 - A Systematic Approach to Pancreatic Cysts: An Investigation of the Impact of Standardized Radiology Report Templates on the Management of New Pancreatic Cysts, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
