A multimodality test to guide the management of patients with a pancreatic cyst
2019
Pancreatic cystsare common and often pose a management dilemma, because some
cystsare 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
cystfluid 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 costsassociated with current standard-of-care
pancreatic cystmanagement practices.
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