AI can identify precancerous pancreatic cysts
An international scientific team, led by the Johns Hopkins Kimmel Cancer Center, has shown that a laboratory test using artificial intelligence tools has the potential to more accurately sort out which people with pancreatic cysts will go on to develop pancreatic cancers.
Dubbed CompCyst (for comprehensive cyst analysis), the test was created with patient data including clinical impressions and symptoms, images from CT scans and molecular features such as DNA alterations within cyst fluid. A proof-of-concept study was carried out by researchers including Anne Marie Lennon, Director of the Johns Hopkins Multidisciplinary Pancreatic Cyst Clinic, with the results published in the journal Science Translational Medicine.
Pancreatic cysts are found in 4% of people in their 60s and 8% of people over age 70, but only a small fraction of cysts progress to cancer. As noted by Lennon, “The dilemma facing patients and their physicians is the ability to distinguish precancerous cysts from cysts that will not progress to cancer.”
“Currently available clinical and imaging tests often fail to distinguish precancerous cysts from cysts that have little or no potential to turn cancerous, which makes it difficult to determine which patients will not require follow-up and which patients will need long-term follow-up or immediate surgical resection,” added study investigator Christopher Wolfgang, Director of Surgical Oncology at the Johns Hopkins Kimmel Cancer Center.
“As a result, essentially all people diagnosed with a cyst are followed long term. Surgeons are faced with making recommendations to patients based on the risks and benefits of surgery with limited information. We seldom miss a cancer, but it is at the expense of performing an operation that in hindsight may not have been necessary.”
The study used information from 862 patients with pancreatic cysts who had cyst fluid analysis and cyst removal surgery at The Johns Hopkins Hospital and 15 other medical centres around the world. The precise nature of the cysts was confirmed through histopathological analysis of resected surgical specimens, with the cysts subsequently classified into three groups: those with no potential to turn cancerous, for which patients would not require periodic monitoring; mucin-producing cysts that have a small risk of progressing to cancer, for which patients can receive periodic monitoring for progression to possible cancer; and cysts for which surgery is recommended because there is a high likelihood of progression to cancer.
Based on histopathological analysis of the surgically resected cysts, the researchers found that surgery was not needed for 45% of the patients that underwent surgery for their cysts; this unnecessary surgery was performed because the clinicians could not determine if the cysts were dangerous. The researchers then fed the molecular profiles of the cysts into CompCyst, which classified patients into the three groups noted above. If CompCyst has been used initially, the researchers estimate that 60–74% of the patients (depending on the cyst type) could have been spared unnecessary surgeries.
“Our study demonstrates the potential role of CompCyst as a complement to existing clinical and imaging criteria when evaluating pancreatic cysts,” Lennon said. “It could provide a greater degree of confidence for physicians when they advise patients that they do not require follow-up and can be discharged from surveillance.
“Although we still need to prospectively validate this test, our results are exciting because they document a new and more objective way to manage the many patients with this disease.”
The study had several limitations, the researchers note, including that pancreatic cyst fluid was obtained at the time of surgery and that the cysts evaluated were more atypical than those seen in routine clinical practice. Nevertheless, plans are underway to begin a prospective validation study in the next year.
“We think CompCyst has the capacity to substantially reduce unnecessary surgeries for pancreatic cysts,” said Bert Vogelstein, Co-Director of The Ludwig Center at the Johns Hopkins Kimmel Cancer Center. “Over the next five years, we hope to use CompCyst in many more patients with cysts in an effort to guide surgical treatment — to determine when surgery is needed and when it is not needed — and evaluate how well the test performs.”
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