S222 Risk of Pancreatic Cyst in Genetic High-Risk Group Among Patients From EUS Pancreas Registry

Introduction: Pancreatic cysts and certain genetically high-risk (GHR) groups are routinely under surveillance/screening for pancreatic cancer early detection. The degree of influence of pancreatic cysts in genetically high-risk groups requires further characterization for future management. Here we describe the comparison of groups with either genetic-risks and/or suspected pancreatic mucinous cysts from the institutional EUS Pancreas Registry. Methods: Data were obtained from the institutional IRB-approved EUS Pancreas Registry for pancreatic disease. Three groups were examined: GHR individuals (family history of pancreatic ductal adenocarcinoma or presence of high-risk genetic mutations) without cysts (Group 1), GHR individuals with cysts (Group 2), and individuals with a history of pancreatic cysts alone (Group 3). Fukuoka and Kyoto guideline risk features were counted and summed for each case and metric was calculated for per-year risk feature development. Those with pancreatitis related cysts, serous cysts, neuroendocrine tumor, pancreaticobiliary cancer without cyst were excluded. Descriptive statistics and non-parametric comparisons (Kruskal-Wallis with Bonferroni correction) were performed using SPSS v30. Statistical significance was set at P < 0.05. Results: Of 220 patients (63.6% women; mean age 62.5 years), racial breakdown included 78.2% Caucasian, 8.2% Asian, 8.2% Hispanic, and 5.4% African American. Cancer or high-grade dysplasia was found in 0 of 49 cases (0%) in Group 1, 3 of 27 cases (11.1%) in Group 2, and 30 of 144 cases (20.8%) in Group 3. Guideline-based risk scoring showed no significant difference between Groups 1 and 2. However, significant differences were observed between Groups 1 and 3 (Fukuoka (P = 0.002) and Kyoto (P = 0.000)). Group 2 and Group 3 also showed significant differences (Fukuoka (P = 0.007) and Kyoto (P = 0.043)). Conclusion: An increasing trend of the observed cancer is seen in association with pancreatic cyst formation. Risk-feature-based scoring demonstrated significant differences under both the Fukuoka and Kyoto guidelines between the pancreatic cyst alone group and GHR groups (with and without cyst). The current risk-feature based strategy, however, did not definitively distinguish the risk of having a cyst within the GHR group. These findings highlight the potential value of data analysis in stratifying cancer risk and underscore the need for further research to refine risk assessment strategies.