International Consensus Guidelines for Surgical Resection of Mucinous Neoplasms Cannot Be Applied to All Cystic Lesions of the Pancreas

Sawhney, Mandeep S.; Albashir, Siwar; Cury, Marcelo S.; Brown, Alphonso; Chuttani, Ram; Pleskow, Douglas K.; Callery, Mark P.; Vollmer, Charles M.

doi:10.1016/j.cgh.2009.06.026

Cited by 53 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies to validate these guidelines revealed clear limitations in the sensitivity and specificity of the recommended measurements, therefore, more reliable biomarkers than those used in the Sendai guidelines are needed for the optimal management of individual patients (Table 1). 7–9 …”

Section: Introductionmentioning

confidence: 99%

Cystic precursors to invasive pancreatic cancer

Matthaei

Schulick

Hruban

et al. 2011

Nat Rev Gastroenterol Hepatol

168

144

View full text Add to dashboard Cite

Improvements in the sensitivity and quality of cross-sectional imaging have led to increasing numbers of patients being diagnosed with cystic lesions of the pancreas. In parallel, clinical, radiological, pathological and molecular studies have improved the systems for classifying these cysts. Patients with asymptomatic serous cystic neoplasms can be managed conservatively with regular monitoring; however, the clinical management of patients with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms is far more challenging, as it is difficult to determine whether these lesions will progress to malignancy. Fortunately, prospective studies have helped to establish that proposed clinical and radiological criteria (the Sendai guidelines) can be used to guide the care of patients with cystic lesions of the pancreas. Despite this progress in imaging and clinical guidelines, sensitive and specific tests have not yet been developed that can reliably predict the histology and biological properties of a cystic lesion. Such biomarkers are urgently needed, as noninvasive precursors of pancreatic cancer are curable, while the vast majority of invasive pancreatic adenocarcinomas are not.

show abstract

Section: Introductionmentioning

confidence: 99%

Cystic precursors to invasive pancreatic cancer

Matthaei

Schulick

Hruban

et al. 2011

Nat Rev Gastroenterol Hepatol

168

144

View full text Add to dashboard Cite

show abstract

“…[11027] Furthermore, Sawhney showed that although cyst size was a predictor of malignancy in pancreatic cysts, nearly half (9 / 21) of the malignant cysts were < 3 cm. [2829]…”

Section: Discussionmentioning

confidence: 99%

Cytological analysis of small branch-duct intraductal papillary mucinous neoplasms provides a more accurate risk assessment of malignancy than symptoms

et al. 2011

View full text Add to dashboard Cite

Objectives:The Sendai guidelines for management of patients with clinically suspected intraductal papillary mucinous neoplasms (IPMN) recommend resection of cysts > 30 mm, a dilated main pancreatic duct (MPD) > 6 mm, a mural nodule (MN), symptoms or positive cytology. Although sensitive, asymptomatic cysts, nonspecific symptoms, and a high threshold for positive cytology limit the specificity of the guidelines. We have assessed the value of cytology relative to symptom for predicting malignancy in IPMNs without high-risk imaging features.Materials and Methods:We retrospectively reviewed the clinical, radiological, and cytological data of 31 small branch-duct IPMNs without a MN. The cytological presence of high-grade atypical epithelial cells (HGA) was considered true positive, with a corresponding histology of high-grade dysplasia or invasive carcinoma. The performance of cytology versus symptoms was evaluated by calculating the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy.Results:The sensitivity (0.80), specificity (0.85), and accuracy (0.84) of HGA were higher than the corresponding performance characteristics of symptoms (0.60, 0.45, and 0.48, respectively). The NPV of no HGA on cytology was > 95%.Conclusions:Cytology is a better predictor of malignancy than symptoms, for the conservative management of small branch-duct IPMNs. Cytology contributes to a highly accurate triple negative test for malignancy in small IPMN: No dilated MPD, MN or HGA.

show abstract

“…Sawhney et al [36] studied the interesting question of whether the consensus guidelines can be applied to all pancreatic cystic lesions, and found that some malignant cystic lesions are missed when consensus criteria are applied to all lesions as opposed to BDIPMN alone. These results suggest modified consensus criteria could better identify malignancy in pancreatic cystic lesions.…”

Section: Resection Of the Pancreatic Lesion: When To Operatementioning

confidence: 99%

Pancreatic Cystic Lesions: When to Watch, When to Operate, and When to Ignore

Turner

Brugge

2010

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Pancreatic cystic lesions are being increasingly identified with the widespread use of state-of-the-art imaging. These lesions are categorized into a broad range of neoplastic cysts and inflammatory pseudocysts. Identification of a pancreatic cyst requires the clinician to focus on the main clinical challenge of the benign or malignant nature of the cyst. Neoplastic cysts range the spectrum from benign, to premalignant, to frank malignancy. The management of these lesions is difficult, and the decision to resect or observe a lesion is hampered by limitations in current imaging and tissue sampling techniques that prevent the accurate characterization of all lesions. This article reviews current guidelines for the evaluation of pancreatic cystic lesions, underscores the challenges posed by these lesions, and discusses current and future studies that will aid in patient management.

show abstract

International Consensus Guidelines for Surgical Resection of Mucinous Neoplasms Cannot Be Applied to All Cystic Lesions of the Pancreas

Cited by 53 publications

References 19 publications

Cystic precursors to invasive pancreatic cancer

Cystic precursors to invasive pancreatic cancer

Cytological analysis of small branch-duct intraductal papillary mucinous neoplasms provides a more accurate risk assessment of malignancy than symptoms

Pancreatic Cystic Lesions: When to Watch, When to Operate, and When to Ignore

Contact Info

Product

Resources

About