Alba Manuel-Vázquez1, Anita Balakrishnan2, Paul Agami3, Bodil Andersson4, Frederik Berrevoet5, Marc G Besselink6, Ugo Boggi7, Damiano Caputo8, Alberto Carabias9, Lucia Carrion-Alvarez10, Carmen Cepeda Franco11, Alessandro Coppola8, Bobby V M Dasari12, Sherley Diaz-Mercedes13, Michail Feretis14, Constantino Fondevila15, Giuseppe Kito Fusai16, Giuseppe Garcea17, Victor Gonzabay15, Miguel Ángel Gómez Bravo11, Myrte Gorris6, Bart Hendrikx5, Camila Hidalgo-Salinas16, Prashant Kadam12, Dimitrios Karavias18, Emanuele Kauffmann7, Amar Kourdouli17, Vincenzo La Vaccara8, Stijn van Laarhoven19, James Leighton20, Mike S L Liem21, Nikolaos Machairas16, Dimitris Magouliotis22, Adel Mahmoud18, Marco V Marino23, Marco Massani24, Paola Melgar Requena25, Keno Mentor20, Niccolò Napoli7, Jorieke H T Nijhuis21, Andrej Nikov26, Cristina Nistri24, Victor Nunes27, Eduardo Ortiz Ruiz28, Sanjay Pandanaboyana20, Baltasar Pérez Saborido29, Radek Pohnán26, Mariuca Popa17, Belinda Sánchez Pérez30, Francisco Sánchez Bueno31, Alejandro Serrablo32, Mario Serradilla-Martín32, James R A Skipworth19, Kjetil Soreide33, Dimitris Symeonidis22, Dimitris Zacharoulis22, Piotr Zelga14, Daniel Aliseda34, María Jesús Castro Santiago35, Carlos Fernández Mancilla36, Raquel Latorre Fragua37, Daniel Llwyd Hughes38, Carmen Payá Llorente39, Mickaël Lesurtel40, Tom Gallagher41, José Manuel Ramia25. 1. Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain. alba_manuel_vazquez@hotmail.com. 2. Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, and Department of Surgery, University of Cambridge, Cambridge, UK. 3. Moscow Clinical Scientific Center, Moscow, Russia. 4. Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden. 5. Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium. 6. Academic Medical Center, Amsterdam, The Netherlands. 7. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. 8. General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy. 9. Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain. 10. General Surgery Department, HPB Unit Fuenlabrada University Hospital, Madrid, Spain. 11. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain. 12. Queen Elizabeth Hospital Birmingham, Birmingham, UK. 13. Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain. 14. Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK. 15. Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain. 16. Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK. 17. Leicester General Hospital, University Hospitals of Leicester, Leicester, UK. 18. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 19. Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. 20. Freeman Hospital, Newcastle upon Tyne, UK. 21. Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands. 22. Department of Surgery, University Hospital of Larissa, Larissa, Greece. 23. Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 24. Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy. 25. Hospital General Universitario de Alicante, Alicante, Spain. 26. Department of Surgery, Military University Hospital Prague, Prague, Czech Republic. 27. HPB Surgery, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal. 28. Department of Pathology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain. 29. Department of General and Digestive Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain. 30. Hospital Regional de Málaga, Malaga, Spain. 31. HPB Surgery, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain. 32. Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain. 33. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. 34. Clínica Universidad De Navarra, Pamplona, Spain. 35. Hospital Universitario Puerta Del Mar, Cadiz, Spain. 36. Hospital Universitario San Juan De Alicante, Alicante, Spain. 37. Hospital Universitario De Guadalajara, Guadalajara, Spain. 38. Department of HPB Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK. 39. Hospital Universitario Doctor Peset, Valencia, Spain. 40. Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Hospices Civils de Lyon, Lyon, France. 41. Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
Abstract
PURPOSE: A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. METHODS: An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. RESULTS: A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. CONCLUSION: Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
PURPOSE: A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. METHODS: An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. RESULTS: A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. CONCLUSION: Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
Authors: Karla Bernardi; Oscar A Olavarria; Julie L Holihan; Lillian S Kao; Tien C Ko; John S Roth; Shawn Tsuda; Khashayar Vaziri; Mike K Liang Journal: Ann Surg Date: 2020-03 Impact factor: 12.969