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A multimodality test to guide the management of patients with a pancreatic cyst.

Simeon U SpringerDavid L MasicaMarco Dal MolinChristopher B DouvilleChristopher J ThoburnBahman AfsariLu LiJoshua David CohenElizabeth D ThompsonPeter J AllenDavid S KlimstraMark A SchattnerC Max SchmidtMichele T Yip-SchneiderRachel E SimpsonCarlos Fernandez-Del CastilloMari A Mino-KenudsonWilliam BruggeRandall E BrandAatur D SinghiAldo ScarpaRita Teresa LawlorRoberto SalviaGiuseppe ZamboniSeung-Mo HongDae-Wook HwangJin-Young JangWooil KwonNiall SwanJustin GeogheganMassimo FalconiStefano CrippaClaudio DoglioniJorge PaulinoRichard D SchulickBarish H EdilWalter ParkShinichi YachidaSusumu HijiokaJeanin van HooftJin HeMatthew J WeissRichard BurkhartMartin MakaryMarcia I CantoMichael G GogginsJanine PtakLisa DobbynJoy SchaeferNatalie SillmanMaria PopoliAlison P KleinCristian TomasettiRachel KarchinNickolas PapadopoulosKenneth W KinzlerBert VogelsteinChristopher L WolfgangRalph H HrubanAnne Marie Lennon
Published in: Science translational medicine (2020)
Pancreatic cysts are common and often pose a management dilemma, because some cysts are 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 cyst fluid 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 costs associated with current standard-of-care pancreatic cyst management practices.
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