PTU-76 Prevalence and follow-up of Mucinous Pancreatic Cystic Lesions in a cohort of inpatients

Abstract

<h3>Introduction</h3> There has been an increasing interest in pancreatic cystic lesions over the past couple of decades due to malignant potential of certain types of pancreatic cysts particularly intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) of the pancreas. A previous study showed prevalence of cystic lesions was 9.3% in a cohort of patients attending for Magnetic resonance imaging [1]. A prospective population-based Study using magnetic resonance cholangiopancreaticography (MRCP) showed a prevalence of 49.1% for pancreatic cysts with a criteria of diameter ≥2mm and a 5-year follow-up revealed an incidence of 2.6% per year in general population [2]. We present our data for patients who were identified to have pancreatic cystic lesions during inpatient episodes and follow-up subsequently for suspected mucinous lesions. <h3>Methodology</h3> Data search was performed using the ICD-10 codes D13.6 (Benign neoplasm of pancreas), K86.2 (Cyst of pancreas) and K86.3 (Pseudocyst of pancreas). Demographics, diagnosis and follow up data of patients with pancreatic cystic lesions identified between 2011 and 2020 were analysed. Data regarding diagnostics such as Endoscopic ultrasound (EUS) and fine needle aspiration (FNA) and MDT discussions were recorded. Histopathological findings were also recorded for those who were referred for surgery. <h3>Results</h3> Over a 10-year period a total of 162 inpatients were identified as having pancreatic cystic lesions. The age range was 20-91 years with an average of 66 years, 63% were over the age of 65 years and 42% were males. The median follow-up duration was 4 years. 42% patients (n=68) had pseudocysts. 33% (n=55) were found to have IPMNs, of these 49 patients had side-branch IPMNs, 4 patients had main-duct IPMNs and 2 patients had mixed IPMN. MCN and serous cystadenomas were identified in 4% each. Other lesions include simple pancreatic cysts (20 patients), pancreatic neuroendocrine tumors (NETs, 3 patients), pancreatic cancers (4 patients) and indeterminate lesions (one patient) accounted for 17% of the total number of patients. 7 patients (4.3%) were referred for surgery, 4 had invasive adenocarcinoma and one patient had high grade dysplasia. <h3>Conclusion</h3> Prevalence of mucinous neoplastic lesions in this cohort of patients with Pancreatic Cystic Lesions was 38%. 4.3% of patients who needed surgery were main-duct IPMN (3patients) and mucinous cystic neoplasms (4 patients). The most common histological type was invasive adenocarcinomas. Interestingly, no patients with side-branch IPMN needed surgical resection in this cohort suggesting a relatively low risk of progression to malignancy. This data may help planning for follow up services for this cohort of patients. <h3>References</h3> de Oliveira PB, Puchnick A, Szejnfeld J, <i>et al</i>. Prevalence of incidental pancreatic cysts on 3 tesla magnetic resonance. <i>PLoS One</i> 2015;10:e0121317 Kromrey M-L, <i>et al</i>. Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. <i>Gut</i> 2018;67:138–145. doi:10.1136/gutjnl-2016-313127