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European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Hepatobiliary-Pancreas

Which is the best current guideline for the diagnosis and management of cystic pancreatic neoplasms? An appraisal using evidence-based practice methods

Authors: Alexis M. Cahalane, Y. M. Purcell, L. P. Lavelle, S. H. McEvoy, E. R. Ryan, E. O’Toole, D. E. Malone

Published in: European Radiology | Issue 9/2016

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Abstract

Background and aim

Cystic pancreatic neoplasms (CPNs) are an increasingly diagnosed entity. Their heterogeneity poses complex diagnostic and management challenges. Despite frequently encountering these entities, particularly in the context of the increased imaging of patients in modern medicine, doctors have to rely on incomplete and ambiguous published literature. The aim of this project was to review the guidelines relating to CPNs using evidence-based practice (EBP) methods.

Methods

A search of both the primary and secondary literature was performed. Five sets of guidelines were identified which were then methodologically appraised by the AGREE II instrument, a validated and widely utilised tool for guideline development assessment.

Results

The 2014 ‘Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms’ were found to be the most methodologically sound guidelines, on the basis of both the overall score and average weighted domain score.

Conclusions

The current best guidelines were identified. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument can be used for retrospective review of published guidelines or as a roadmap for guideline-writing groups. All guidelines found were methodologically limited. Further longitudinal/prospective studies are required to improve the level of evidence.

Key Points

• Cystic pancreatic neoplasms (CPNs) are an increasingly encountered entity in modern medicine.
• Clinical uncertainty remains with regard to optimal diagnostic and management strategies.
• The Italian consensus guidelines for cystic pancreatic neoplasms are currently the best guidelines.
Literature
1.
Compagno J, Oertel JE (1978) Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 69:573–580CrossRefPubMed
2.
Compagno J, Oertel JE (1978) Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol 69:289–298CrossRefPubMed
3.
Yeo CJ, Sarr MG (1994) Cystic and pseudocystic diseases of the pancreas. Curr Probl Surg 31:165–243CrossRefPubMed
4.
Gaujoux S, Brennan MF, Gonen M et al (2011) Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg 212:590–600, discussion 600–593CrossRefPubMed
5.
6.
7.
Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553CrossRefPubMed
8.
Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y (1995) Analysis of small cystic lesions of the pancreas. Int J Pancreatol 18:197–206PubMed
9.
Girometti R, Intini S, Brondani G et al (2011) Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: prevalence and relation with clinical and imaging features. Abdom Imaging 36:196–205CrossRefPubMed
10.
de Jong K, Nio CY, Mearadji B et al (2012) Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas 41:278–282CrossRefPubMed
11.
Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084CrossRefPubMed
12.
Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL (2003) Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138:427–423, discussion 433–424CrossRefPubMedPubMedCentral
13.
Valsangkar NP, Morales-Oyarvide V, Thayer SP et al (2012) 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 152:S4–12CrossRefPubMedPubMedCentral
14.
Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL (2004) Cystic neoplasms of the pancreas. N Engl J Med 351:1218–1226CrossRefPubMed
15.
Katz MH, Mortenson MM, Wang H et al (2008) Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. J Am Coll Surg 207:106–120CrossRefPubMed
16.
Enestvedt BK, Ahmad N (2013) To cease or 'de-cyst'? The evaluation and management of pancreatic cystic lesions. Curr Gastroenterol Rep 15:348CrossRefPubMed
17.
Pitman MB, Lewandrowski K, Shen J, Sahani D, Brugge W, Fernandez-del Castillo C (2010) Pancreatic cysts: preoperative diagnosis and clinical management. Cancer Cytopathol 118:1–13CrossRefPubMed
18.
Khalid A, Brugge W (2007) ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 102:2339–2349CrossRefPubMed
19.
Cho CS, Russ AJ, Loeffler AG et al (2013) Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol 20:3112–3119CrossRefPubMedPubMedCentral
20.
Guidelines. IoMUCoSfDTCP (2011) In: Robin Graham MM, Dianne Miller W, Sheldon G, Earl S (eds) Clinical Practice Guidelines We Can Trust. National Academies Press (US), Washington
21.
Coroneos CJ, Voineskos SH, Cornacchi SD, Goldsmith CH, Ignacy TA, Thoma A (2014) Users' guide to the surgical literature: how to evaluate clinical practice guidelines. Can J Surg 57:280–286CrossRefPubMedPubMedCentral
22.
Berland LL, Silverman SG, Megibow AJ, Mayo-Smith WW (2014) ACR members' response to JACR white paper on the management of incidental abdominal CT findings. J Am Coll Radiol 11:30–35CrossRefPubMed
23.
24.
Barajas-Nava L, Sola I, Delgado-Noguera M et al (2010) Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal. Qual Saf Health Care 19:e50PubMed
25.
Medves J, Godfrey C, Turner C et al (2010) Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. Int J Evid Based Healthc 8:79–89PubMed
26.
Grimshaw J, Eccles M, Tetroe J (2004) Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof 24(Suppl 1):S31–37CrossRefPubMed
27.
Hakkennes S, Dodd K (2008) Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care 17:296–300CrossRefPubMed
28.
Grimshaw JM, Thomas RE, MacLennan G et al (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8(iii-iv):1–72
29.
Siering U, Eikermann M, Hausner E, Hoffmann-Esser W, Neugebauer EA (2013) Appraisal tools for clinical practice guidelines: a systematic review. PLoS One 8:e82915CrossRefPubMedPubMedCentral
30.
Del Chiaro M, Verbeke C, Salvia R et al (2013) European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 45:703–711CrossRefPubMed
31.
Tanaka M, Fernandez-del Castillo C, Adsay V et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMed
32.
Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773CrossRefPubMed
33.
34.
35.
Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D (2005) A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care 17:235–242CrossRefPubMed
36.
Burgers JS, Cluzeau FA, Hanna SE, Hunt C, Grol R (2003) Characteristics of high-quality guidelines: evaluation of 86 clinical guidelines developed in ten European countries and Canada. Int J Technol Assess Health Care 19:148–157CrossRefPubMed
37.
(2011) Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 edn. The Cochrane Collaboration
38.
Buscarini E, Pezzilli R, Cannizzaro R et al (2014) Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 46:479–493CrossRefPubMed
39.
Sahani DV, Kambadakone A, Macari M, Takahashi N, Chari S, Fernandez-del Castillo C (2013) Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 200:343–354CrossRefPubMed
40.
Kosmahl M, Pauser U, Peters K et al (2004) Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 445:168–178CrossRefPubMed
41.
Farrell JJ, Fernandez-del Castillo C (2013) Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 144:1303–1315CrossRefPubMed
42.
McAlister FA, van Diepen S, Padwal RS, Johnson JA, Majumdar SR (2007) How evidence-based are the recommendations in evidence-based guidelines? PLoS Med 4:e250CrossRefPubMedPubMedCentral
43.
Raine R, Sanderson C, Hutchings A, Carter S, Larkin K, Black N (2004) An experimental study of determinants of group judgments in clinical guideline development. Lancet 364:429–437CrossRefPubMed
44.
Nast A, Erdmann R, Hofelich V et al (2009) Do guidelines change the way we treat? Studying prescription behaviour among private practitioners before and after the publication of the German Psoriasis Guidelines. Arch Dermatol Res 301:553–559CrossRefPubMed
45.
Fervers B, Burgers JS, Haugh MC et al (2005) Predictors of high quality clinical practice guidelines: examples in oncology. Int J Qual Health Care 17:123–132CrossRefPubMed
46.
Acuna-Izcaray A, Sanchez-Angarita E, Plaza V et al (2013) Quality assessment of asthma clinical practice guidelines: a systematic appraisal. Chest 144:390–397CrossRefPubMed
47.
Brosseau L, Rahman P, Poitras S et al (2014) A systematic critical appraisal of non-pharmacological management of rheumatoid arthritis with Appraisal of Guidelines for Research and Evaluation II. PLoS One 9:e95369CrossRefPubMedPubMedCentral
48.
Ou Y, Goldberg I, Migdal C, Lee PP (2011) A critical appraisal and comparison of the quality and recommendations of glaucoma clinical practice guidelines. Ophthalmology 118:1017–1023CrossRefPubMed
49.
Schmidt S, Follmann M, Malek N, Manns MP, Greten TF (2011) Critical appraisal of clinical practice guidelines for diagnosis and treatment of hepatocellular carcinoma. J Gastroenterol Hepatol 26:1779–1786CrossRefPubMed
50.
Nast A, Spuls PH, Ormerod AD et al (2009) A critical appraisal of evidence-based guidelines for the treatment of psoriasis vulgaris: 'AGREE-ing' on a common base for European evidence-based psoriasis treatment guidelines. J Eur Acad Dermatol Venereol 23:782–787CrossRefPubMed
51.
Nougaret S, Reinhold C, Chong J et al (2014) Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol 24:1020–1029CrossRefPubMed
52.
Budde C, Beyer G, Kuhn JP, Lerch MM, Mayerle J (2015) The Clinical and Socio-Economic Relevance of Increased IPMN Detection Rates and Management Choices. Viszeralmedizin 31:47–52CrossRefPubMedPubMedCentral
53.
Oh JS, Koea JB (2014) Radiation risks associated with serial imaging in colorectal cancer patients: should we worry? World J Gastroenterol 20:100–109CrossRefPubMedPubMedCentral
54.
Manfredi R, Ventriglia A, Mantovani W et al (2015) Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization. Eur Radiol 25:940–949CrossRefPubMed
55.
Purysko AS, Gandhi NS, Walsh RM, Obuchowski NA, Veniero JC (2014) Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm? Eur Radiol 24:3134–3141CrossRefPubMed
56.
MacIntyre CR, Plant AJ, Hendrie D (2001) Shifting the balance between in-patient and out-patient care for tuberculosis results in economic savings. Int J Tuberc Lung Dis 5:266–271PubMed
57.
Sabharwal S, Gauher S, Kyriacou S, Patel V, Holloway I, Athanasiou T (2014) Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery. Bone Joint J 96-b:19–23CrossRefPubMed
58.
Metadata
Title
Which is the best current guideline for the diagnosis and management of cystic pancreatic neoplasms? An appraisal using evidence-based practice methods
Authors
Alexis M. Cahalane
Y. M. Purcell
L. P. Lavelle
S. H. McEvoy
E. R. Ryan
E. O’Toole
D. E. Malone
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4160-y

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