Integrated molecular pathology accurately determines the malignant potential of pancreatic cysts
Integrated molecular pathology accurately determines the malignant potential of pancreatic cysts
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DOI：
10.1055/s-0034-1390742
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发表时间：
2015-02-01
期刊：
影响因子：
9.3
通讯作者：
Catalano, Marc F.
中科院分区：
文献类型：
--
作者：
Al-Haddad, Mohammad A.;Kowalski, Thomas;Catalano, Marc F.
背景和研究目的：目前的诊断测试是不足以确定胰腺囊肿的恶性潜力，导致过于谨慎的病人管理。综合分子病理学（IMP）检测将分子分析与一线检测结果（细胞学、影像学和液体化学）相结合，以评估胰腺囊肿的恶性潜能。这项多中心研究旨在确定IMP对胰腺癌的诊断准确性，以及根据当前指南建议进行IMP检测对管理胰腺囊肿的实用性。患者和方法：纳入了之前按照医生处方接受过IMP检测且临床结果可通过回顾性记录审查获得的患者（n=492）。通过临床结局与既往IMP诊断之间的相关性（“良性”/“统计学惰性”vs.“统计学较高风险[SHR]"/“侵袭性”）或国际共识指南（Sendai 2012）“监测”vs.“手术”标准模型确定性能。考克斯比例风险模型确定了恶性肿瘤的风险比。结果：良性和统计学惰性IMP诊断有97%的概率良性随访长达7年8个月，从最初的IMP测试。SHR和侵袭性诊断的恶性肿瘤相对危险比分别为30.8和76.3（均P
Background and study aims: Current diagnostic testing is inadequate to determine the malignant potential of pancreatic cysts, resulting in overcautious patient management. Integrated molecular pathology (IMP) testing combines molecular analysis with first-line test results (cytology, imaging, and fluid chemistry) to assess the malignant potential of pancreatic cysts. This multicenter study aimed to determine the diagnostic accuracy of IMP for pancreatic adenocarcinoma, and the utility of IMP testing under current guideline recommendations for managing pancreatic cysts.Patients and methods: Patients who had undergone previous IMP testing as prescribed by their physician and for whom clinical outcomes were available from retrospective record review were included (n=492). Performance was determined by correlation between clinical outcome and previous IMP diagnosis ("benign"/"statistically indolent" vs. "statistically higher risk [SHR]"/ "aggressive") or an International Consensus Guideline (Sendai 2012) criteria model for "surveillance" vs. "surgery." The Cox proportional hazards model determined hazard ratios for malignancy.Results: Benign and statistically indolent IMP diagnoses had a 97% probability of benign follow-up for up to 7 years and 8 months from initial IMP testing. SHR and aggressive diagnoses had relative hazard ratios for malignancy of 30.8 and 76.3, respectively (both P