Diagnostic accuracy of the AGA, IAP, and European guidelines for detecting advanced neoplasia in intraductal papillary mucinous neoplasm/neoplasia

Follow-up in patients with intraductal papillary mucinous neoplasm (IPMN) aims to detect advanced neoplasia (high-grade dysplasia/cancer) in an early stage. The 2015 American Gastroenterological Association (AGA), 2017 International Association of Pancreatology (IAP), and the 2018 European Study Gro...

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Published in:Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2023-04, Vol.23 (3), p.251-257
Main Authors: van Huijgevoort, Nadine C.M., Hoogenboom, Sanne A.M., Lekkerkerker, Selma J., Busch, Olivier R., Del Chiaro, Marco, Fockens, Paul, Somers, Inne, Verheij, Joanne, Voermans, Rogier P., Besselink, Marc G., van Hooft, Jeanin E.
Format: Article
Language:English
Subjects:
Carcinoma, Pancreatic Ductal - diagnosis
Carcinoma, Pancreatic Ductal - pathology
Carcinoma, Pancreatic Ductal - surgery
Humans
Neoplasms, Cystic, Mucinous, and Serous
Pancreas - pathology
Pancreatic Cyst - diagnosis
Pancreatic Cyst - pathology
Pancreatic Cyst - surgery
Pancreatic Intraductal Neoplasms - diagnosis
Pancreatic Intraductal Neoplasms - pathology
Pancreatic Intraductal Neoplasms - surgery
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Retrospective Studies
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Summary:Follow-up in patients with intraductal papillary mucinous neoplasm (IPMN) aims to detect advanced neoplasia (high-grade dysplasia/cancer) in an early stage. The 2015 American Gastroenterological Association (AGA), 2017 International Association of Pancreatology (IAP), and the 2018 European Study Group on Cystic tumours of the Pancreas (European) guidelines differ in their recommendations on indications for surgery. However, it remains unclear which guideline is most accurate in predicting advanced neoplasia in IPMN. Patients who underwent surgery were extracted from a prospective database (January 2006–January 2021). In patients with IPMN, final pathology was compared with the indication for surgery according to the guidelines. ROC-curves were calculated to determine the diagnostic accuracy for each guideline. Overall, 247 patients underwent surgery for cystic lesions. In 145 patients with IPMN, 52 had advanced neoplasia, of which the AGA guideline would have advised surgery in 14 (27%), the IAP and European guideline in 49 (94%) and 50 (96%). In 93 patients without advanced neoplasia, the AGA, IAP, and European guidelines would incorrectly have advised surgery in 8 (8.6%), 77 (83%) and 71 (76%). The European and IAP guidelines are clearly superior in detecting advanced neoplasia in IPMN as compared to the AGA, albeit at the cost of a higher rate of unnecessary surgery. To harmonize care and to avoid confusion caused by conflicting statements, a global evidence-based guideline for PCN in collaboration with the various guidelines groups is required once the current guidelines require an update.
ISSN:1424-3903
1424-3911
DOI:10.1016/j.pan.2023.01.011