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01-02-2015 | Original Article

Current Recommendations for Surveillance and Surgery of Intraductal Papillary Mucinous Neoplasms May Overlook Some Patients with Cancer

Authors: Andrew H. Nguyen, Paul A. Toste, James J. Farrell, Barbara M. Clerkin, Jennifer Williams, V. Raman Muthusamy, Rabindra R. Watson, James S. Tomlinson, O. Joe Hines, Howard A. Reber, Timothy R. Donahue

Published in: Journal of Gastrointestinal Surgery | Issue 2/2015

Abstract

Background

The 2012 Sendai Criteria recommend that patients with 3 cm or larger branch duct intraductal papillary mucinous neoplasms (BD-IPMN) without any additional “worrisome features” or “high-risk stigmata” may undergo close observation. Furthermore, endoscopic ultrasound (EUS) is not recommended for BD-IPMN <2 cm. These changes have generated concern among physicians treating patients with pancreatic diseases. The purposes of this study were to (i) apply the new Sendai guidelines to our institution’s surgically resected BD-IPMN and (ii) reevaluate cyst size cutoffs in identifying patients with lesions harboring high-grade dysplasia or invasive cancer.

Methods

We retrospectively reviewed 150 patients at a university medical center with preoperatively diagnosed and pathologically confirmed IPMNs. Sixty-six patients had BD-IPMN. Pathologic grade was dichotomized into low-grade (low or intermediate grade dysplasia) or high-grade/invasive (high-grade dysplasia or invasive cancers). Fisher’s exact test, chi-square test, student’s t test, linear regression, and receiver operating characteristic (ROC) analyses were performed.

Results

The median BD-IPMN size on imaging was 2.4 cm (interquartile range 1.5–3.0). Fifty-one (77 %) low-grade and 15 (23 %) high-grade/invasive BD-IPMN were identified. ROC analysis demonstrated that cyst size on preoperative imaging is a reasonable predictor of grade with an area under the curve of 0.691. Two-thirds of high-grade/invasive BD-IPMN were <3 cm (n = 10). Compared to a cutoff of 3, 2 cm was associated with higher sensitivity (73.3 vs. 33.3 %) and negative predictive value (83.3 vs. 80 %, NPV) for high-grade/invasive BD-IPMN. Mural nodules on endoscopic ultrasound (EUS) or atypical cells on endoscopic ultrasound-fine needle aspiration (EUS-FNA) were identified in all cysts <2 and only 50 % of those <3 cm. Forty percent of cysts >3 cm were removed based on size alone.

Discussion/Conclusions

Our results suggest that “larger” size on noninvasive imaging can indicate high-grade/invasive cysts, and EUS-FNA may help identify “smaller” cysts with high-grade/invasive pathology.

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Title: Current Recommendations for Surveillance and Surgery of Intraductal Papillary Mucinous Neoplasms May Overlook Some Patients with Cancer
Authors: Andrew H. Nguyen
Paul A. Toste
James J. Farrell
Barbara M. Clerkin
Jennifer Williams
V. Raman Muthusamy
Rabindra R. Watson
James S. Tomlinson
O. Joe Hines
Howard A. Reber
Timothy R. Donahue
Publication date: 01-02-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2693-z

At a glance: The STEP trials

Springer Medicine

Current Recommendations for Surveillance and Surgery of Intraductal Papillary Mucinous Neoplasms May Overlook Some Patients with Cancer

Abstract

Background

Methods

Results

Discussion/Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Discussion/Conclusions

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