A tug-of-war in intraductal papillary mucinous neoplasms management: Comparison between 2017 International and 2018 European guidelines.
Aged
Early Detection of Cancer
/ standards
Endosonography
/ standards
Europe
Female
Humans
Male
Middle Aged
Pancreatectomy
/ standards
Pancreatic Intraductal Neoplasms
/ diagnosis
Pancreatic Neoplasms
/ diagnosis
Practice Guidelines as Topic
Predictive Value of Tests
Retrospective Studies
Risk Assessment
/ standards
Sensitivity and Specificity
Endoscopic ultrasound
Guidelines
Intraductal papillary mucinous neoplasms
Pancreatic cancer
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
04
11
2020
revised:
02
03
2021
accepted:
04
03
2021
pubmed:
14
4
2021
medline:
3
2
2022
entrez:
13
4
2021
Statut:
ppublish
Résumé
2017 International and 2018 European guidelines are the most recent guidelines for intraductal papillary mucinous neoplasms management. to evaluate the diagnostic accuracy of these guidelines in identifying malignant IPMN. 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. 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 moderate-risk 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. 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.
Sections du résumé
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 moderate-risk 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.
Identifiants
pubmed: 33846103
pii: S1590-8658(21)00125-0
doi: 10.1016/j.dld.2021.03.009
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
998-1003Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest No author has conflicts of interest to declare.