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Chronic Pancreatitis II: Collaborative Care01:29

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Cross-Modality Differences In Pancreatic Cyst Size Measurements May Affect Surgical Decision-Making.

Tamir E Bresler1, Sari Lada2, Shivam Pandya1

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Preoperative imaging of pancreatic cysts shows significant size variability between MRI, CT, and endoscopic ultrasound (EUS). This discrepancy can misclassify lesions around the 3 cm surgical threshold, impacting patient management decisions.

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Area of Science:

  • Gastroenterology and Hepatology
  • Medical Imaging
  • Surgical Oncology

Background:

  • Accurate preoperative measurement of pancreatic cystic lesions is crucial for surgical decision-making, especially concerning the 3 cm resection guideline.
  • Discrepancies in size estimates from different imaging modalities can potentially alter patient management strategies.

Purpose of the Study:

  • To evaluate the variability in preoperative size measurements of pancreatic cystic lesions across different imaging modalities.
  • To assess the concordance of these measurements with the 3 cm surgical threshold and its impact on clinical decision-making.

Main Methods:

  • Retrospective review of 190 patients undergoing EUS-FNA for pancreatic cystic lesions with available MRI and/or CT data.
  • Extraction of the largest dimension for each modality (MRI, CT, EUS) and statistical analysis of mean size differences using ANOVA.
  • Calculation of concordance across the 3 cm surgical threshold using Cohen's κ.

Main Results:

  • Mean cyst sizes were comparable across modalities (MRI: 2.93 cm, EUS: 2.95 cm, CT: 3.20 cm), with no statistically significant differences (P = .194).
  • Mean absolute size differences ranged from 0.7 to 0.9 cm, with some outliers exceeding 2 cm.
  • Good agreement was observed between EUS and MRI (κ = 0.643), and moderate agreement between EUS and CT (κ = 0.472) at the 3 cm cutoff.

Conclusions:

  • Substantial variability exists in preoperative size assessment of pancreatic cystic lesions, leading to 7.5-20% misclassification around the critical 3 cm threshold.
  • Reliance on a single imaging modality can introduce bias in surgical decision-making.
  • Multimodality assessment is recommended to reduce discordance and improve risk stratification for pancreatic cystic lesions.