Surgical Management of Intraductal Papillary Mucinous Tumors of the Pancreas

Gigot, Jean‐François; Deprez, Pierre Henri; Sempoux, Christine; Descamps, Charles; Métairie, Sylvie; Glineur, David; Gianello, Pierre

doi:10.1001/archsurg.136.11.1256

Cited by 74 publications

(17 citation statements)

References 26 publications

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“…Similarly, there are few data to guide the use of frozen sections in evaluating resection margins for IPMNs without an associated invasive carcinoma. Although the evidence is not strong, further resection is recommended if high-grade dysplasia is present at a resection margin at the time of frozen section 72 . Due to the low probability of a positive result, evaluation of margin status may be inconsequential for cases with branch duct IPMNs without main duct dilatation.…”

Section: Resultsmentioning

confidence: 99%

A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas

Basturk

Hong

Wood

et al. 2015

American Journal of Surgical Pathology

685

528

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International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to invasive carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: 1) To improve concordance and to align with practical consequences, a two-tiered system (low vs. high-grade) is proposed for all precursor lesions, with the provision that the current PanIN-2 and neoplasms with intermediate-grade dysplasia now be categorized as low-grade. Thus, “high-grade dysplasia” is to be reserved for only the uppermost end of the spectrum (“carcinoma in situ” type lesions). 2) Current data indicate that PanIN of any grade at a margin of a resected pancreas with invasive carcinoma does not have prognostic implications; the clinical significance of dysplasia at a margin in a resected pancreas with IPMN lacking invasive carcinoma remains to be determined. 3) Intraductal lesions 0.5–1 cm can be either large PanINs or small IPMNs. The term “incipient IPMN” should be reserved for lesions in this size with intestinal- or oncocytic-papillae or GNAS mutations. 4) Measurement of the distance between an IPMN and invasive carcinoma and sampling of intervening tissue are recommended to assess concomitant versus associated status. Conceptually, concomitant invasive carcinoma (in contrast with the “associated” group) ought to be genetically distinct from an IPMN elsewhere in the gland. 5) “Intraductal spread of invasive carcinoma” (aka, “colonization”) is recommended to describe lesions of invasive carcinoma invading back into and extending along the duct system, which may morphologically mimic high-grade PanIN or even IPMN. 6) “Simple mucinous cyst” is recommended to describe cysts > 1 cm having gastric-type flat mucinous lining at most minimal atypia without ovarian-type stroma to distinguish them from IPMN. 7) Human lesions resembling the acinar-to-ductal metaplasia and atypical flat lesions of genetically engineered mouse models exist and may reflect an alternate pathway of carcinogenesis; however, their biological significance requires further study. These revised recommendations are expected to improve our management and understanding of precursor lesions in the pancreas.

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Section: Resultsmentioning

confidence: 99%

A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas

Basturk

Hong

Wood

et al. 2015

American Journal of Surgical Pathology

685

528

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“…Extra-prostatic extension and positive surgical margin are respectively present in 21-28% [ 26 , 27 ] and 21-42% [ 24 , 28 ] of patients undergoing radical prostatectomy, and they are both correlated with poor prognosis [ 26 , 28 – 30 ]. For some cancers, histopathology of frozen sections is used to evaluate the optimal extent of resection [ 31 – 33 ]; however, this technique cannot be used to test surgical margins during radical prostatectomy without disrupting the workflow. Typically, it is only after a few days, once the prostate is completely removed and the specimen has been processed (formalin-fixed and paraffin-embedded, FFPE), typically a few days following radical prostatectomy, that the presence of cancer at the surgical margins can be assessed.…”

Section: Introductionmentioning

confidence: 99%

Combining high wavenumber and fingerprint Raman spectroscopy for the detection of prostate cancer during radical prostatectomy

Aubertin¹,

Desroches²,

Jermyn³

et al. 2018

Biomed. Opt. Express

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For prostate cancer (PCa) patients, radical prostatectomy (complete removal of the prostate) is the only curative surgical option. To date, there is no clinical technique allowing for real-time assessment of surgical margins to minimize the extent of residual cancer. Here, we present a tissue interrogation technique using a dual excitation wavelength Raman spectroscopy system capable of sequentially acquiring fingerprint (FP) and high wavenumber (HWN) Raman spectra. Results demonstrate the ability of the system to detect PCa in post-prostatectomy specimens. In total, 477 Raman spectra were collected from 18 human prostate slices. Each area measured with Raman spectroscopy was characterized as either normal or cancer based on histopathological analyses, and each spectrum was classified based on supervised learning using support vector machines (SVMs). Based on receiver operating characteristic (ROC) analysis, FP (area under the curve [AUC] = 0.89) had slightly superior cancer detection capabilities compared with HWN (AUC = 0.86). Optimal performance resulted from combining the spectral information from FP and HWN (AUC = 0.91), suggesting that the use of these two spectral regions may provide complementary molecular information for PCa detection. The use of leave-one-(spectrum)-out (LOO) or leave-one-patient-out (LOPO) cross-validation produced similar classification results when combining FP with HWN. Our findings suggest that the application of machine learning using multiple data points from the same patient does not result in biases necessarily impacting the reliability of the classification models.

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“…19,20,22,40,47,49,57,58,61,[63][64][65][66] Although many surgical series have used frozen sections to help guide the extent of resection for IPMNs, less than half have reported the frequency with which they were positive. [16][17][18][19][20][21][22][23][30][31][32][33][34]38 Comparison of rates of positivity of the resection margins between studies is confounded by the use of different grading systems for dysplasia, by varying definitions of what constitutes a positive margin, and by variable inclusion of IPMNs with associated invasive carcinoma. Most studies published subsequent to 2000 and before 2018 have used the 3-tiered WHO system 67,68 or equivalent 3-tiered terminologies for grading dysplasia in IPMNs and have classified margins involved by IPMN exhibiting any degree of dysplasia as a positive margin.…”

Section: Discussionmentioning

confidence: 99%

The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms

2022

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ObjectivesThe utility of frozen section evaluation of the pancreatic parenchymal resection margin(s) in the surgical management of intraductal papillary mucinous neoplasm (IPMN) remains controversial. We investigated the frequency of its use in IPMN resections and its impact on achievement of negative final parenchymal margin(s).MethodsSixty-two IPMN resections (11 with invasive carcinoma) performed over a 12-year period were studied.ResultsFrozen sections of the parenchymal margin(s) were performed on 44 of the 62 resections (71%), 30 (68%) of which had 10 positive and 22 indefinite margins on frozen section. Additional margin resections were performed in 14 of these 30 cases (47%), boosting the complete resection rate from 14% (2 of 14) on the initial margin(s) to 71% (10 of 14) on the final margin(s) (P = 0.002). Overall, negative final parenchymal margin(s) were achieved more frequently when evaluation of the initial margin(s) by frozen section was performed (35 of 44; 80%) than when it was not (11 of 18; 61%) (P = 0.13).ConclusionsIn the intraoperative management of IPMN, frozen sections are highly reliable for margin evaluation and are useful for guiding the extent of pancreatic resection.

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Surgical Management of Intraductal Papillary Mucinous Tumors of the Pancreas

Cited by 74 publications

References 26 publications

A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas

A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas

Combining high wavenumber and fingerprint Raman spectroscopy for the detection of prostate cancer during radical prostatectomy

The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms

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