Research ArticleCancer

A multimodality test to guide the management of patients with a pancreatic cyst

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Science Translational Medicine  17 Jul 2019:
Vol. 11, Issue 501, eaav4772
DOI: 10.1126/scitranslmed.aav4772

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Pancreatic prognostication

Early, accurate detection of pancreatic cancer is a high priority. However, not all pancreatic cysts develop into cancer and they can be difficult to triage, leading to both missed diagnoses and unnecessary surgeries. Springer, Masica, and Dal Molin et al. developed a machine-learning method that integrates high-dimensional clinical, imaging, and molecular data to diagnose and determine the likely best course of action for patients with pancreatic cysts: discharge and no follow-up, discharge and routine monitoring, or surgery. The test, tuned to avoid discharging patients with potential malignancies, outperformed the current standard of care in managing patients in all groups, demonstrating its potential for both clinicians and patients.

Abstract

Pancreatic cysts are common and often pose a management dilemma, because some cysts are precancerous, whereas others have little risk of developing into invasive cancers. We used supervised machine learning techniques to develop a comprehensive test, CompCyst, to guide the management of patients with pancreatic cysts. The test is based on selected clinical features, imaging characteristics, and cyst fluid genetic and biochemical markers. Using data from 436 patients with pancreatic cysts, we trained CompCyst to classify patients as those who required surgery, those who should be routinely monitored, and those who did not require further surveillance. We then tested CompCyst in an independent cohort of 426 patients, with histopathology used as the gold standard. We found that clinical management informed by the CompCyst test was more accurate than the management dictated by conventional clinical and imaging criteria alone. Application of the CompCyst test would have spared surgery in more than half of the patients who underwent unnecessary resection of their cysts. CompCyst therefore has the potential to reduce the patient morbidity and economic costs associated with current standard-of-care pancreatic cyst management practices.

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