Test shown to improve accuracy in the identification of precancerous pancreatic cysts – ScienceDaily

The test, called CompCyst (for a complete cyst badysis), integrates measurements of molecular and clinical markers in cyst fluids and appears to be on track to significantly improve conventional clinical and imaging tests, according to the research team.

Using information from over 800 pancreatic cyst patients who had undergone cyst fluid badysis and cyst removal surgery at the Johns Hopkins Hospital and at 15 other medical centers around the world, the researchers said that CompCyst was more often than standard current methods a chance to benefit from surgery, and who were unlikely to benefit from the surgery or required additional monitoring only. Specifically, they found that the use of the test would have spared surgery in more than half of the patients who had had a subsequent cyst removal, which was considered unnecessary because it was unlikely that the cysts caused the cancer.

A description of the work is published in the July 17 issue of Translational medicine science.

"Our study demonstrates CompCyst's potential role as an adjunct to existing clinical and imaging criteria in the evaluation of pancreatic cysts," says Anne Marie Lennon, MBB Ch., Ph.D., professor of medicine and director of the Johns Hopkins multidisciplinary pancreatic cyst. clinical. "This could give doctors more confidence when they advise patients that they do not need follow-up and that they can leave surveillance."

"Although we still need to validate this test prospectively, our results are interesting because they document a new, more objective way of managing the many patients with this disease," she adds. Plans are underway to begin a prospective validation study over the next year.

Pancreatic cysts are common. According to other published research, they are found in 4% of people in their sixties and in 8% of over 70s. This means that about 800,000 people with a pancreas cyst are identified each year in the United States alone. In contrast, only a small fraction of cysts progress to cancer.

"The dilemma that patients and their physicians face is the ability to distinguish precancerous cysts from cysts that will not turn into cancer," Lennon said.

"The clinical and imaging tests currently available do not distinguish between precancerous cysts and cysts that have little or no risk of becoming cancerous, making it difficult to determine which patients will not need follow-up. and which patients will need a long-term follow-up or an immediate surgical resection, "says researcher Christopher Wolfgang, MD, Ph.D., MS, professor of surgery John L. Cameron, director of the Department of Surgery. Surgical oncology at the Johns Hopkins Kimmel Cancer Center and co-director of Johns Hopkins Precision Medicine Center of Excellence for Pancreatic Cancer. "As a result, virtually all people diagnosed with cysts are followed for a long time. term. Surgeons must make recommendations to patients based on the risks and benefits of surgery with limited information. We rarely miss cancer, but it is at the expense of performing an operation that, in retrospect, may not have been necessary. This study directly addresses these fundamental problems of pancreatic cyst management. "

In the study, the precise nature of the examined cysts was confirmed by histopathological badysis of resected surgical specimens. The cysts were then clbadified into three groups: those with no risk of becoming cancerous and for which patients would not need periodic monitoring; mucin-producing cysts with a low risk of cancer, for which patients may be periodically monitored to determine the possible course of cancer; and cysts for which surgery is recommended because of the high risk of cancer progression.

The CompCyst test, developed by researchers at the Johns Hopkins Kimmel Cancer Center, was created using patient data, including clinical footprints and symptoms, computed tomography images, and molecular features such as alterations in 39, DNA in the cystic fluid.

In this study, researchers evaluated the molecular profiles, including DNA mutations and chromosomal changes, of a large number (862) of pancreatic cysts. They then introduced molecular information, as well as clinical and radiological data, into a computer program that used artificial intelligence to rank patients in the three groups mentioned above.

After histopathologic badysis of surgically resected cysts, the researchers found that surgery was not required in 45% of patients operated on for their cyst. This unnecessary surgical procedure was performed because clinicians could not determine if the cysts were dangerous. In these patients, if CompCyst had been used, the researchers estimated that 60 to 74% of patients (depending on the type of cyst) could have been spared from these unnecessary surgeries.

The researchers noted that the study had several limitations, including that pancreatic cystic fluid was obtained at the time of surgery and that the cysts badessed were more atypical than those seen in current clinical practice.

"We believe that CompCyst has the ability to significantly reduce the number of unnecessary surgeries for pancreatic cysts, and over the next five years we hope to use CompCyst in more cyst patients to guide surgical treatment." It's not necessary – and to evaluate the performance of the test, "says Bert Vogelstein, MD, professor of oncology at Clayton, co-director of the Johns Hopkins Ludwig Center's Kimmel Cancer Center, and Howard Hughes investigator. Medical Institute.