I-Shiow Jan1,2, Ming-Chu Chang3,4, Ching-Yao Yang5,6, Yu-Wen Tien5,6, Yung-Ming Jeng7,8, Chih-Horng Wu9,10, Bang-Bin Chen9,10, Yu-Ting Chang11,12. 1. Department of Laboratory Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. 2. Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 3. Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. 4. Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei, 100, Taiwan. 5. Department of Surgery, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. 6. Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 7. Department of Pathology, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. 8. Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 9. Department of Medical Image, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. 10. Department of Medical Image, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 11. Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan. yutingchang@ntu.edu.tw. 12. Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei, 100, Taiwan. yutingchang@ntu.edu.tw.
Abstract
BACKGROUND: Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs. METHODS: One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups-absolute, relative indications, and conservative approach-according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated. RESULTS: One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC. CONCLUSIONS: The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs.
BACKGROUND: Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs. METHODS: One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups-absolute, relative indications, and conservative approach-according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated. RESULTS: One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC. CONCLUSIONS: The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs.
Authors: Patrick Michl; Matthias Löhr; John P Neoptolemos; Gabriele Capurso; Vinciane Rebours; Nuria Malats; Mathilde Ollivier; Luigi Ricciardiello Journal: United European Gastroenterol J Date: 2021-08-25 Impact factor: 6.866
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