Single-institution validation of the international consensus guidelines for treatment of branch duct intraductal papillary mucinous neoplasms of the pancreas.
BACKGROUND
The international consensus guidelines (the guidelines) for management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas recommend surgical resection of branch duct IPMNs with any of the following features: cyst size >30 mm, mural nodules, main pancreatic duct diameter >6 mm, positive cytology, and symptoms. The aim of this study was to evaluate the usefulness of these guidelines for resection of branch duct IPMNs.


METHODS
We reviewed 84 consecutive patients with branch duct IPMNs who underwent surgical resection at our hospital between January 1984 and December 2007.


RESULTS
Sixty-nine patients had indications for resection according to the guidelines. Malignant IPMNs had significantly larger cysts than benign tumors (P = 0.026). Patients with malignant IPMNs had significantly more indications for resection than those with benign IPMNs (2.6 +/- 1.0 vs. 1.7 +/- 0.9, P < 0.001), and 36 of the 37 patients with malignant IPMNs had indications. The sensitivity of the guidelines for predicting malignancy was 97.3%. One of 15 patients without indications had malignancy, and the specificity was low (29.8%).


CONCLUSIONS
The guidelines show a high sensitivity for predicting malignancy of branch duct IPMNs, but the specificity is low. The cyst size and the total number of indications in each patient should be taken into account when predicting the risk of malignancy for branch duct IPMNs.
Nagai
Kazuyuki
K
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, 54 Shogoinkawaracho, Sakyo, Kyoto, 606-8507, Japan.
Doi
Ryuichiro
R
Ito
Tatsuo
T
Kida
Atsushi
A
Koizumi
Masayuki
M
Masui
Toshihiko
T
Kawaguchi
Yoshiya
Y
Ogawa
Kohei
K
Uemoto
Shinji
S
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000592:standards; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed