An observational study in Pancreatic Mucinous Cystic Neoplasm, Pancreatic Serous Cystic Neoplasm and Pancreatic Pseudocyst, sponsored by Ruijin Hospital. Not yet recruiting at 1 site in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-11-05.
Sponsored by Ruijin Hospital · Observational
Pancreatic mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), and pancreatic pseudocysts (PPCs) often exhibit overlapping imaging features on endoscopic ultrasound (EUS). However, these conditions require different clinical management strategies. Accurate differentiation is therefore important for appropriate treatment planning.
This study aims to develop and validate an artificial intelligence (AI) model that integrates EUS images and clinical features to differentiate MCNs, SCNs, and PPCs. The study is designed as an ambispective observational diagnostic study consisting of retrospective model development, prospective temporal validation, and a reader study involving EUS physicians.
Approximately 400 adult patients with confirmed MCN, SCN, or PPC will be included. Retrospective clinical data and EUS images will be used for model development and internal validation. After model development is completed, newly diagnosed patients will be prospectively enrolled to independently evaluate the diagnostic performance of the model.
The primary outcome is the patient-level macro-averaged area under the receiver operating characteristic curve (macro-AUROC) for three-class classification in the prospective validation cohort. Secondary outcomes include diagnostic accuracy, sensitivity, specificity, calibration, clinical net benefit, and the performance of EUS physicians with and without AI assistance.
This study is expected to provide evidence for the potential clinical value of AI-assisted differentiation of pancreatic cystic lesions. No additional invasive procedures or study-specific treatments will be performed.
This study is an ambispective observational diagnostic study designed to develop and independently validate a multimodal artificial intelligence (AI) model for differentiating pancreatic mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), and pancreatic pseudocysts (PPCs) using endoscopic ultrasound (EUS) images and clinical features.
**Study Design**
Approximately 400 adult patients with a final diagnosis of MCN, SCN, or PPC will be included. The study consists of two stages: retrospective model development and prospective temporal validation. A reader study will also be conducted to evaluate the potential benefits of AI assistance for EUS physicians.
**Stage 1: Retrospective Model Development**
Approximately 310 patients will be retrospectively identified from existing clinical databases. EUS images, clinical characteristics available before EUS examination, and final diagnostic information will be collected.
MCN and SCN diagnoses will be established using surgical or histopathological findings. PPC will be diagnosed according to a predefined composite reference standard based on clinical history, imaging findings, and other relevant diagnostic evidence.
Separate models will be developed using EUS images alone, clinical features alone, and the combination of EUS images and clinical features. Multiple EUS images from the same patient will be aggregated to generate a single patient-level prediction. Patient-level stratified cross-validation will be used for internal validation, with measures implemented to prevent data leakage.
**Stage 2: Prospective Temporal Validation**
After the AI model and analysis procedures have been finalized, approximately 80-100 consecutive eligible patients will be prospectively enrolled for independent temporal validation. These patients will not be used for model training, feature selection, or parameter optimization.
The primary outcome will be the patient-level macro-averaged area under the receiver operating characteristic curve (macro-AUROC) for three-class classification of MCN, SCN, and PPC. Each disease category will be evaluated using a one-vs-rest approach, and the three AUROC values will be averaged. A 95% confidence interval will be estimated using bootstrap resampling.
Secondary evaluations will include overall accuracy, macro-F1 score, weighted F1 score, class-specific sensitivity, specificity, positive predictive value, negative predictive value, model calibration, and clinical net benefit.
**Reader Study**
EUS physicians with different levels of experience will independently evaluate selected cases. Diagnostic performance will be compared among physicians without AI assistance, the AI model alone, and physicians with AI assistance. Diagnostic confidence, interobserver agreement, and interpretation time will also be assessed.
**Model Interpretability**
Gradient-weighted class activation mapping (Grad-CAM) or attention-based visualization will be used to identify image regions contributing to model predictions. Shapley additive explanations (SHAP) will be used to evaluate the contributions of clinical variables.
Exploratory analyses will investigate model performance across predefined patient subgroups, the potential incremental value of EUS videos, and differences among pathological subtypes of MCN.
**Clinical Procedures and Patient Safety**
All EUS examinations, pathological assessments, and clinical treatments will be performed according to routine clinical practice. No additional invasive procedures or study-specific therapeutic interventions will be required. AI predictions during prospective validation will not be used to guide clinical decisions.
32 studies on the registry are indexed under Pancreatic Pseudocyst; 10 are open to participants now.
This study's planned enrollment of 400 is above the median of 210 across 10 observational studies indexed under Pancreatic Pseudocyst.
Browse Pancreatic Pseudocyst studies →Ruijin Hospital is the lead sponsor of 679 studies on the registry; 387 are open to participants now.
Counted across the registry records on this site, refreshed daily.
The study population will consist of approximately 400 adult patients aged 18 years or older with a final diagnosis of pancreatic mucinous cystic neoplasm (MCN), serous cystic neoplasm (SCN), or pancreatic pseudocyst (PPC) who have undergone endoscopic ultrasound (EUS) at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Approximately 310 retrospective patients will be identified from existing clinical records for AI model development and internal validation. An additional 80-100 eligible patients will be consecutively enrolled for prospective temporal validation after model finalization. MCN and SCN diagnoses will be confirmed by pathology, whereas PPC diagnoses will be established using a predefined composite reference standard. Each patient will contribute one independent study sample regardless of the number of available EUS images.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
**Inclusion Criteria:**
**Exclusion Criteria:**
Exclusion Criteria:
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Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).
Your pathology report is the document that shows this.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Histologically or cytologically confirmed
The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).
Your pathology report is the document that shows this.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adult patients with pancreatic mucinous cystic neoplasms (MCNs) confirmed by surgical or histopathological examination. Eligible patients will have undergone endoscopic ultrasound (EUS) as part of routine clinical care. EUS images and pre-examination clinical data will be collected for AI model development and validation. Both retrospective and prospective cases will be included.
Adult patients with pancreatic serous cystic neoplasms (SCNs) confirmed by surgical or histopathological examination. Eligible patients will have undergone endoscopic ultrasound (EUS) as part of routine clinical care. EUS images and pre-examination clinical data will be collected for AI model development and validation. Both retrospective and prospective cases will be included.
Adult patients diagnosed with pancreatic pseudocysts (PPCs) according to a predefined composite reference standard incorporating clinical history, imaging findings, and relevant diagnostic evidence. Eligible patients will have undergone endoscopic ultrasound (EUS) as part of routine clinical care. EUS images and pre-examination clinical data will be collected for AI model development and validation. Both retrospective and prospective cases will be included.
Patient-Level Macro-AUROC of the Multimodal AI Model for Three-Class Classification of MCN, SCN, and PPC
The diagnostic performance of the locked multimodal artificial intelligence (AI) model will be evaluated in an independent prospective temporal validation cohort using the patient-level macro-averaged area under the receiver operating characteristic curve (macro-AUROC). One-vs-rest AUROC will be calculated separately for mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), and pancreatic pseudocysts (PPCs). The three AUROC values will then be averaged with equal weighting. Each patient will contribute one final prediction, and 95% confidence intervals will be estimated using bootstrap resampling. Higher values indicate better discrimination.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Overall Patient-Level Classification Accuracy of the AI Model
Overall accuracy will be calculated as the proportion of patients correctly classified as MCN, SCN, or PPC among all patients evaluated in the prospective validation cohort. Accuracy will be reported as a percentage with a 95% confidence interval.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Macro-Averaged F1 Score of the AI Model
The F1 score will be calculated separately for MCN, SCN, and PPC using the harmonic mean of precision and recall. The macro-F1 score will be calculated as the unweighted average of the three class-specific F1 scores. Values range from 0 to 1, with higher values indicating better classification performance.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Difference in Patient-Level Macro-AUROC Between Multimodal and Unimodal AI Models
The difference in patient-level macro-AUROC between the locked multimodal AI model and each unimodal model (EUS image-only and clinical feature-only) will be calculated in the independent prospective validation cohort. Each comparison will be reported as the arithmetic difference in macro-AUROC, with positive values indicating better discrimination by the multimodal model.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Calibration Intercept of the Multimodal AI Model
The calibration intercept of the locked multimodal AI model will be estimated in the prospective validation cohort to assess systematic overestimation or underestimation of predicted probabilities. A value closer to 0 indicates better calibration.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Change in Physicians' Diagnostic Accuracy With AI Assistance
EUS physicians with different levels of experience will evaluate cases with and without AI assistance. The primary measure for the reader study will be the paired difference in patient-level three-class diagnostic accuracy between AI-assisted and unaided interpretation. Additional reader outcomes will include macro-AUROC, macro-F1 score, diagnostic confidence, interobserver agreement, and interpretation time.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Difference in Patient-Level Classification Accuracy Between Multimodal and Unimodal AI Models
The difference in overall patient-level classification accuracy between the locked multimodal AI model and each unimodal model (EUS image-only and clinical feature-only) will be calculated in the independent prospective validation cohort. Differences will be expressed in percentage points, with positive values indicating higher accuracy for the multimodal model.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Calibration Slope of the Multimodal AI Model
The calibration slope of the locked multimodal AI model will be estimated in the prospective validation cohort to assess the agreement between the spread of predicted probabilities and observed outcomes. A value closer to 1 indicates better calibration.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
Multiclass Brier Score of the Multimodal AI Model
The multiclass Brier score will be calculated as the mean, across patients, of the sum of squared differences between the predicted probabilities for MCN, SCN, and PPC and their corresponding observed class indicators. The unnormalised score ranges from 0 to 2, with lower values indicating better probabilistic predictions.
Time frame: At completion of diagnostic assessment in the prospective temporal validation cohort, through December 2028.
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