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Results: Four hundred ninety-two cases (66 malignant) with surgical pathology (n=209) or long-term follow-up of 2.0-7.7 yrs (n=283) were analyzed (Table 1). 31/492 initially had HRS; 461/492 initially lacked HRS. Malignancy was found in 58% initially having HRS. Malignancy was found in only 10% initially lacking HRS, but in 30% when 2-3 DNA abnormalities were also initially present, and only 3% when all DNA abnormalities were initially absent. Malignancy was found in 4% initially lacking HRS and all WF, but in 9% when 2-3 DNA abnormalities were also initially present. Malignancy was found in 17% initially lacking HRS and having 1 WF, but in 50% when 2-3 DNA abnormalities were also initially present, and in only 2% when all DNA abnormalities were initially absent. Malignancy was found in 30% initially lacking HRS and having 2 or more WF, but in 80% when 2-3 DNA abnormalities were also initially present, and in only 8% when all DNA abnormalities were initially absent.
Discussion: In the absence of HRS, analysis of pancreatic cysts for TSG mutations, KRAS, and DNA quantity provides value to assessing risk of future malignancy. The presence of 2 or more DNA abnormalities can help identify patients in need of more aggressive management. The absence of all DNA abnormalities can help identify patients in need of less aggressive management.
References: 1. Al-Haddad MA, et al. Endoscopy 2015; 47:1-11.