Ann Surg Treat Res.  2016 Mar;90(3):124-130. 10.4174/astr.2016.90.3.124.

Validation of international consensus guideline 2012 for intraductal papillary mucinous neoplasm of pancreas

• Han DH
• Lee H
• Park JY
• Kwon W
• Heo JS
• Choi SH
• Choi DW

• KMID: 2155045
• DOI: http://doi.org/10.4174/astr.2016.90.3.124

Abstract

PURPOSE
Intraductal papillary mucinous neoplasm (IPMN) has variable malignant potential ranging from premalignant intraductal lesions to malignant neoplasms with invasive carcinoma. To help physicians managing patients with IPMN, International consensus guidelines was made in 2006 and revised in 2012. This study was designed to evaluate the clinical usefulness of guidelines and to validate.
METHODS
From October 1996 to December 2011, we retrospectively reviewed the data of 230 patients who underwent pancreatic resection for IPMN. Univariate and multivariable analyses were used to identify significant predictors of malignancy in IPMN.
RESULTS
Of the 230 patients, 62 patients (27%) were diagnosed with invasive carcinoma. Jaundice (P < 0.001; 95% confidence interval [CI], 3.086-40.010) main pancreatic duct diameter equal to or greater than 10 mm (P < 0.001; 95% CI, 1.723-6.673) and also abdominal pain (P < 0.001; 95% CI, 4.363-22.600) show statistical significance in univariate and multivariate analysis. "High-risk stigmata" was statistical powerful predictors of malignancy than "worrisome features". International consensus guidelines 2012 had improvement on specificity but deterioration of sensitivity.
CONCLUSION
Revised guidelines seemed to bring about an improvement of weak side of Sendai criteria. Abdominal pain, jaundice, main pancreas duct greater than 10 mm can be clinical variables to predict malignancy.

Keyword

Neoplasms; Pancreas; Mucinous; Cystic; Guideline

MeSH Terms

Abdominal Pain
Consensus*
Humans
Jaundice
Mucins*
Multivariate Analysis
Pancreas*
Pancreatic Ducts
Retrospective Studies
Sensitivity and Specificity
Mucins

Figure

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  Fig. 1 Classification of IPMN patients based on International Consensus Guideline 2006. IPMN, intraductal papillary mucinous neoplasm. Sensitivigy, 90%; Specificity, 34%; positive predictive value, 41%; negative predictive value, 87%.

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  Fig. 2 Classification of IPMN patients based on International Consensus Guideline 2012. IPMN, intraductal papillary mucinous neoplasm. Sensitivigy, 55%; Specificity, 78%; positive predictive value, 55%; negative predictive value, 78%.

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  Fig. 3 (A) Disease-free survival between "With ICG2006" group and "Without ICG2006" group. (B) Disease-free survival between "With ICG2012" group and "Without ICG2012" group. ICG, international consensus guideline.

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  Fig. 4 (A) Overall survival between "With ICG2006" group and "Without ICG2006" group. (B) Overall survival between "With ICG2012" group and "Without ICG2012" group guideline 2012. ICG, international consensus guideline.

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