Patients 65 years and older with incidental pancreatic cysts: Is there a relationship between all-cause mortality and imaging follow-up?

• Adults ≥ 65 years old with incidental pancreatic cysts (IPC) don’t have higher mortality risk compared to those without IPC.
• Adults 65- 84 with IPC are more likely to have follow-up abdominal CT and MRI than those without IPC.
• Increased number of follow up imaging studies is not associated with decreased odds of death.
• Fewer surveillance studies may be appropriate for older subjects with small IPC.

PurposeTo assess the relationship between imaging follow-up and all-cause mortality in subjects ≥65 years with and without incidental pancreatic cysts (IPC).Methods and materialsPatients ≥65 years with abdominal CT/MR 11/1/01-11/1/11 were included. IPC group included subjects with IPC on CT/MR report; No-IPC group was 3:1 frequency-matched on age decade, imaging modality and year of initial study from the pool without reported IPC. Demographics, date of last encounter, date of death, Charlson scores within 3 months before initial CT/MR and number of abdominal CTs and MRs performed after initial study were recorded. Logistic regression models with binary outcomes of death and having post-index imaging were constructed. Models were adjusted for age, race, sex, Charlson score and follow-up time. Subgroups were created based on interactions between variables.ResultsThere were 1320 subjects in IPC group and 3805 in No-IPC group, with mean ages 79.1 (±8.0) and 78.8 (±8.0) years, respectively (p = 0.293), and median follow-up times of 3.1 (IQR 0.74–5.26) and 3.0 (0.36–5.23) years, respectively (p = 0.009). Adjusted odds ratios of post-index imaging for IPC were 2.18 (p < 0.001) in subgroup <84 years and follow-up <4years, 3.37 (p < 0.001) in subgroup <84 years and follow-up ≥4 years, and 1.20 (p = 0.201) in subgroup ≥84 years. Number of follow-up CTs and MRs was not independently associated with decreased odds of death in any subgroup.ConclusionOlder subjects with IPC are more likely to undergo imaging follow-up compared to subjects without IPC, yet increasing number of follow-up studies does not decrease the odds of death.