TY - JOUR
T1 - Small and Stable Pancreatic Cysts Are Reassuring During Surveillance
T2 - Results From the PACYFIC Trial
AU - Levink, Iris J. M.
AU - Sprij, Marloes L. J. A.
AU - Koopmann, Brechtje D. M.
AU - Meziani, Jihane
AU - Jaarsma, Sanne
AU - van Riet, Priscilla A.
AU - Overbeek, Kasper A.
AU - Gorris, Myrte
AU - Voermans, Rogier P.
AU - van Hooft, Jeanin E.
AU - Casadei, Riccardo
AU - Di Marco, Mariacristina
AU - Wallace, Michael B.
AU - Hoogenboom, Sanne A.
AU - Azopardi, Neville
AU - Ahola, Reea
AU - Polkowski, Marcin
AU - Honkoop, Pieter
AU - Carrara, Silvia
AU - Schoon, Erik J.
AU - Venneman, Niels G.
AU - van der Waaij, Laurens A.
AU - van Berkel, Anne-Marie
AU - Rossi, Gemma
AU - Bergmann, Jilling F.
AU - Pando, Elizabeth
AU - Beyer, Georg
AU - Schwartz, Matthijs P.
AU - van Vilsteren, Frederike G. I.
AU - Hoge, Chantal
AU - Smits, Marianne E.
AU - Quispel, Rutger
AU - van Soest, Ellert J.
AU - Vos, Patrick M.
AU - Verdonk, Robert C.
AU - Steinhauser, Toon
AU - Kouw, Eva
AU - Tan, Adriaan C. I. T. L.
AU - Czako, Laszlo
AU - Bruno, Marco J.
AU - Cahen, Djuna L.
AU - PACYFIC Study Work Group
PY - 2025/7
Y1 - 2025/7
N2 - Background: Pancreatic cysts are increasingly discovered on imaging studies performed for unrelated conditions. Currently, surveillance of these lesions poses a substantial burden on patients, and health care recourses. We hypothesized that individuals with small and stable cysts have a diminutive risk of progressing to high-grade dysplasia (HGD) or pancreatic cancer (PC) that is similar to that in the general population. Methods: This nested PACYFIC-study is a collaboration among 44 centers in Europe and Northern-America, and investigates the risk of HGD and PC for different cyst sizes and growth rates in participants without baseline worrisome features (WF) or high-risk stigmata (HRS). Results: Of the 2369 PACYFIC participants, 975 met the inclusion criteria, with a mean age of 67 years (SD 13) and 65% being female. Of these, 438 individuals (45%) had a baseline small cyst size (< 15 mm), and 885 (91%) individuals had a slow growth rate (< 2.5 mm/year). During a median follow-up of 45 months (IQR 27), 20 individuals (2.1%) developed HGD, or PC. Individuals with small cysts had a 1.5-fold lower risk of developing WF or HRS (hazard ratio [HR] 0.7 [0.5–1.0], p = 0.03) than those with larger cysts but a similar risk of developing HGD or PC (p > 0.05). Slow growth was protective against the development of WF or HRS (HR 0.4 [0.2–0.6], p < 0.001) and HGD or PC (HR 0.04 [95% CI 0.02–0.12], p < 0.001). Individuals with small, stable sized cysts without baseline WF or HRS did not have a higher risk of HGD or PC than the general population (standardized incidence ratio [SIR] 1.13 [95% CI 0.01–6.30]). Conclusion: Cyst size < 15 mm and growth rate < 2.5 mm/year appear to be “reassuring” features associated with a negligible risk of developing WF or HRS and HGD or PC. For cysts with these characteristics—and without baseline WF or HRS—less intensive surveillance (than currently recommended) or even cessation may be appropriate.
AB - Background: Pancreatic cysts are increasingly discovered on imaging studies performed for unrelated conditions. Currently, surveillance of these lesions poses a substantial burden on patients, and health care recourses. We hypothesized that individuals with small and stable cysts have a diminutive risk of progressing to high-grade dysplasia (HGD) or pancreatic cancer (PC) that is similar to that in the general population. Methods: This nested PACYFIC-study is a collaboration among 44 centers in Europe and Northern-America, and investigates the risk of HGD and PC for different cyst sizes and growth rates in participants without baseline worrisome features (WF) or high-risk stigmata (HRS). Results: Of the 2369 PACYFIC participants, 975 met the inclusion criteria, with a mean age of 67 years (SD 13) and 65% being female. Of these, 438 individuals (45%) had a baseline small cyst size (< 15 mm), and 885 (91%) individuals had a slow growth rate (< 2.5 mm/year). During a median follow-up of 45 months (IQR 27), 20 individuals (2.1%) developed HGD, or PC. Individuals with small cysts had a 1.5-fold lower risk of developing WF or HRS (hazard ratio [HR] 0.7 [0.5–1.0], p = 0.03) than those with larger cysts but a similar risk of developing HGD or PC (p > 0.05). Slow growth was protective against the development of WF or HRS (HR 0.4 [0.2–0.6], p < 0.001) and HGD or PC (HR 0.04 [95% CI 0.02–0.12], p < 0.001). Individuals with small, stable sized cysts without baseline WF or HRS did not have a higher risk of HGD or PC than the general population (standardized incidence ratio [SIR] 1.13 [95% CI 0.01–6.30]). Conclusion: Cyst size < 15 mm and growth rate < 2.5 mm/year appear to be “reassuring” features associated with a negligible risk of developing WF or HRS and HGD or PC. For cysts with these characteristics—and without baseline WF or HRS—less intensive surveillance (than currently recommended) or even cessation may be appropriate.
KW - cyst size
KW - high-grade dysplasia
KW - intraductal papillary mucinous neoplasm (IPMN)
KW - pancreatic cancer
KW - pancreatic cyst
KW - stable cyst growth
KW - surveillance
KW - PAPILLARY MUCINOUS NEOPLASMS
KW - TERM-FOLLOW-UP
KW - RISK
KW - MALIGNANCY
KW - FEATURES
U2 - 10.1002/ueg2.70043
DO - 10.1002/ueg2.70043
M3 - Article
SN - 2050-6406
VL - 13
SP - 971
EP - 981
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 6
ER -