A229 QUALITY ASSESSMENT OF SURVEILLANCE PATTERNS OF PATIENTS WITH BRANCH DUCT TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS (BD-IPMN)
Bibliographic record
Abstract
BD-IPMN are typically small neoplastic tumors that are located on the side branches of the main pancreatic duct. These cysts are usually found incidentally with cross-sectional imaging. Although main duct IPMN have high malignant potential, BD-IPMNs are low risk for progression to malignancy therefore surveillance is often appropriate. The 2015 AGA guidelines recommend imaging in one year and then every two years for a total of five years and if the cyst is unchanged, the patient can be discharged from further surveillance. To assess the surveillance pattern of patients diagnosed with BD-IPMN by EUS and compare to AGA guidelines. Secondary objectives included analyzing the proportion of BD-IPMN that progressed and if surveillance methods have changed over the time. A retrospective chart review from 01/11-02/17 of endoscopic ultrasound (EUS) procedures at St. Paul’s Hospital, Vancouver, Canada was performed to identify patients with BD-IPMN. Information acquired included patient demographics, patient co-morbidities, BD-IPMN anatomic location, presence of high-risk features, and surveillance imaging (EUS, CT, MRI) findings. Patient follow up was compared to the recommendations implemented in the AGA guidelines to determine if appropriate surveillance was performed. Acquired data included 324 branch type IPMN patients (out of 1250 EUS procedures) with 30% containing high risk features: 21.6% containing a cyst ≥ 3 cm, 10.5% mural nodularity, and 12.7% having a dilated main pancreatic duct > 5mm. In those undergoing surveillance, recommended follow up was in 98% of patients. From 2011 – 2016, there was a gradual increase in the percentage of patients returning for follow up at our institution with 2016 displaying the highest degree of efficient 1 year follow up at 40%. Despite this, mean percentage of patients undergoing surveillance at year 1, 3 and 5 was 33.4%, 20.2% and 15.7% respectively. No patients developed malignancy during follow up. Although endoscopists recommended follow up routinely in patients with BD-IPMN, only a small proportion of patients adhered to recommendations. The follow up is much better at year one than year 5 and also demonstrates improvement in all parameters over time suggesting increasing compliance. Additionally, the follow up has not demonstrated development of cancer suggesting that these guidelines are reasonable. Other measures to ensure appropriate follow up need to be instituted to ensure compliance with recommended guidelines. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".