ArticleAbdominal radiology (New York)2026
Patient and lesion characteristics associated with follow-up completion for pancreatic cystic lesions detected on MRI.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the association of patient characteristics, community-level social determinants of health, and cyst risk categories with completion of follow-up recommendations for incidental Pancreatic Cystic Lesions (PCLs).
methodsWe retrospectively identified consecutive patients (2013-2023) whose MRI radiology reports described PCLs. A fine-tuned LLaMA-3.1 8B Instruct large language model was used to extract PCL features. Lesions were classified using the 2017 ACR white paper: Category 1 (low risk), Category 2 (worrisome features), or Category 3 (high-risk stigmata). We recorded demographics and follow-up imaging or endoscopic ultrasound dates. Community-level factors were characterized by the 2020 CDC Social Vulnerability Index (SVI), stratified into quartiles. The primary outcome, "inappropriate follow-up," combined late and no follow-up. Multivariable binomial regression was applied to evaluate associations with inappropriate follow-up.
resultsIn 7,745 patients (mean age 66.3 years; 4,796 women), 92.9% (7,198/7,745) of cysts were Category 1, 6.4% (498/7,745) were Category 2, and 0.6% (49/7,745) were Category 3. Only 36.3% of patients completed appropriate follow-up, 12.1% were late, and 51.6% were lost to follow-up. Inappropriate follow-up was high in every cyst category: 64.2% in Category 1, 59.4% in Category 2 and 49.0% in Category 3. In multivariable analysis, non-English primary language (RR 1.08; 95% CI, 1.02-1.14) and residing in more vulnerable communities of the 3rd quartiles of the socioeconomic Social Vulnerability Index subcategory (RR 1.07; 95% CI, 1.02-1.12) were associated with inappropriate follow-up. Higher age-adjusted Charlson Comorbidity Index (CCI ≥ 4) (RR .84; 95% CI, .79-.88), CCI 2-3 (RR .84; 95% CI, .79-.88), and higher-risk cysts in patients under 65 years of age (RR .76; 95% CI, .65-.89) were associated with completed follow-up.
conclusionFollow-up completion for incidental PCLs was low. Factors most consistently associated with follow-up completion were language barriers, residence in socioeconomically vulnerable communities, age-adjusted CCI and higher-risk features among those under 65 years.
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