A tug-of-war in intraductal papillary mucinous neoplasms management: Comparison between 2017 International and 2018 European guidelines

Abstract

Background: 2017 International and 2018 European guidelines are the most recent guidelines for intraductal papillary mucinous neoplasms management. Aim: to evaluate the diagnostic accuracy of these guidelines in identifying malignant IPMN. Methods: data from resected patients with IPMN were collected in two referral centers. Features of risk associated to cancerous degeneration described in International and European guidelines were retrospectively applied. Sensitivity, specificity, positive and negative predictive value in detecting malignant disease were calculated. Results: the study includes 627 resected patients. European guidelines suggest resection in any patient with at least one feature of moderate-risk. International guidelines suggest that patients with moderaterisk features undergo endoscopic ultrasound before surgery. European guidelines had a higher sensitivity (99.2% vs. 83%) but a lower positive predictive value (59.5% vs. 65.8%) and Specificity (2% vs. 37.5%). European guidelines detected almost all malignancies, but 40% of resected patients had low-grade dysplasia. 297 patients underwent endoscopic ultrasound before surgery. 31/116 (26.7%) tumors radiologically classified as "worrisome features" were reclassified as "high-risk stigmata" by endoscopic ultrasound and 24/31 were malignant IPMN. Conclusions: European and International guidelines have a relatively low diagnostic accuracy, being European guidelines more aggressive. Endoscopic ultrasound can improve guidelines accuracy in patients with moderate-risk features.

New Diagnostic Modality Combining Mass Spectrometry and Machine Learning for the Discrimination of Malignant Intraductal Papillary Mucinous Neoplasms

“…The AUC was 0.775, which was equivalent to the value reported by previous clinical research. 11 - 13 However, by adding 129 peak intensities that were almost statistically different between IPMN-LGD and Ad-IPMN, the AUC increased to 0.924, considerably higher than that seen in previous reports. It should be noted that m/z 1035 did not reflect actual serum triglycerides (ref.…”

“… 10 However, there are no definitive methods to predict their properties more accurately, and the latest method achieves a diagnostic accuracy of no more than 63–76%. 11 - 13 …”

Threshold of Main Pancreatic Duct Diameter in Identifying Malignant Intraductal Papillary Mucinous Neoplasm by Magnetic Resonance Imaging

“…Our results were similar to the previous studies. 9 , 21 , 22 Hence, surgical resection is recommended for MD-/MT-IPMNs because of their high malignant potential. 8 , 23 , 24 However, the accurate diagnosis of MD-/MT-IPMNs remained a clinical challenge.…”

Glycemic Abnormalities in Pancreatic Cystic Lesions—A Single-Center Retrospective Analysis

“…In the French experience reported by Duconseil et al, diabetic males with Fukuoka-negative branch-duct IPMN had a malignancy rate of 67% [57]. On the other hand, there is the risk of excessive surgery, with a study from two referral centers in Europe reporting that 40% of patients resected according to European guidelines had only low-grade dysplasia [58]. These results concerning presumptive malignant IPMNs which are not confirmed in the surgical specimen challenge current decision making and raise questions about potentially excessive resections.…”