K. Rawlins1, C. McQuinn2, E. B. Schneider2, P. Muscarella3, M. Dillhoff2, C. R. Schmidt2, L. A. Shirley2 1Ohio State University,College Of Medicine,Columbus, OH, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA 3Albert Einstein College Of Medicine,Department Of Surgery,Bronx, NY, USA
Introduction: Pancreatic cystic lesions are being increasingly discovered due to use of axial imaging. Since risk of malignancy varies greatly based upon lesion type, we sought to examine whether case presentation to a multidisciplinary tumor board was associated with changes in working diagnosis and treatment plan.
Methods: We reviewed all patients who were presented to our institution’s tumor board with a pancreatic cystic lesion from 2012-2015. Patients were divided into six categories based upon lesion type. Pre-discussion diagnosis and treatment plan were compared to post-discussion diagnosis and plan. Corresponding change in diagnosis and plan were examined according to lesion type. Changes in plan were assessed by whether the change was from a less aggressive to a more aggressive treatment option or vice versa. The implementation of treatment plans was also noted.
Results: A total of 208 cases were presented to the tumor board representing 169 individuals who met study criteria. Types of disease included branch-duct Intraductal papillary mucinous neoplasm (BD-IPMN) (32.7%), serous cystadenoma (14.4%), main-duct IPMN (MD-IPMN) (13.9%), pseudocyst (5.8%), mucinous cystic neoplasm (MCN) (3.8%), and other/unknown cystic lesions (29.3%). Overall, post-tumor board diagnosis differed from preliminary 9.6% of the time, varying from other/unknown cystic lesion (23.0%), MCN (12.5%), BD-IPMN (5.9%), and serous cystadenoma (3.3%) (P=0.002). Tumor board recommendations differed from the proposed treatment plan for 44.2% of presented cases; where board recommendations differed from prior planning, tumor board recommended treatment was implemented for 66.3% of patients. Treatment change occurred most frequently with patients who presented with a preliminary diagnosis of serous cystadenoma (60%) followed by other cyst (55.7%), MD-IPMN (41.4%), MCN (37.5%), pseudocyst (33.3%) and BD-IPMN (30.9%) (P=0.034). Of those with a change in plan, 64.8% were from a less aggressive to more aggressive treatment option.
Conclusion: Presentation to a multidisciplinary tumor board is associated with a 9.6% change in diagnosis. A change in treatment recommendations was seen over 40% of the time, with a plan that is considered more aggressive being made in nearly 65% of these cases. Presenting patients with pancreatic cystic lesions to a tumor board may be useful when attempting to accurately diagnose and care for this patient population.