Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2217
Peer-review started: December 13, 2018
First decision: December 28, 2018
Revised: January 27, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: May 14, 2019
The current international guidelines only consider magnetic resonance imaging (MRI) for the follow-up of patients with pancreatic cystic neoplasms (PCN). Given the great number of patients with PCN that have to be followed-up due to the inherent risk of malignant progression, the use of abdominal ultrasound (US) might be a quick, easily accessible and cost-saving imaging modality. Recent publications have evaluated the role of US in monitoring PCN, but none have proposed a safe alternative follow-up surveillance based on US with restricted MRI use.
We performed this study in order to evaluate the safety and cost-efficacy of US as a diagnostic tool to simplify the follow-up of selected patients with low risk pancreatic cystic neoplasms.
The objectives of this study were: (1) to evaluate the safety of the use of US in the surveillance of patients with good acoustic window and low-risk pancreatic cystic neoplasms; and (2) to propose an alternative follow-up protocol that reduces the cost with respect to the cost incurred by current international guidelines.
We retrospectively evaluated the safety and costs of a follow-up surveillance for patients with low-risk PCN, performed with 6 monthly abdominal US for the first year, and then annually and with recourse to MRI scans performed every 2 years, or for confirmation of suspicious US findings.
Between January 2012 and January 2017, we followed 200 patients with a specific protocol that included abdominal US scans for pancreatic cystic neoplasms. During a follow-up period of 25.1 ± 18.2 mo, MRI identified evolution of the lesions not detected by US in only 11 patients (5.5%). However, MRI every 6 mo would not have changed patient management in any case. The mean cost of surveillance for each patient based on theoretical application MRI surveillance (recommended by international guidelines) within the group of patients included in the study would have incurred costs of 1158.9 ± 798.6 €, compared to the surveillance costs incurred by the proposed US-restricted MRI protocol of 366.4 ± 348.7 € (P < 0.0001).
Abdominal US seems to provide a cost-effective surveillance that reduces the frequency of MRI scans without affecting patient outcome. This is important in reducing the financial burden on hospital healthcare, aside from reducing the examination time and MRI-related issues and side effects. For patients with PCN, we have proposed a follow-up surveillance that includes abdominal US, and demonstrated that it is safe and complementary to MRI. In addition, it effectively delays and reduces the number of MRI scans, thereby reducing the cost of surveillance.
The results of the present study need to be confirmed by a comparative prospective randomized trial with both clinical (long-term patient outcome safety) and health economic primary endpoints.