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Digestive Diseases and Sciences

, Volume 63, Issue 4, pp 860–867 | Cite as

Evaluation of the International Consensus Guidelines for the Surgical Resection of Intraductal Papillary Mucinous Neoplasms

  • Mariko Tsukagoshi
  • Kenichiro Araki
  • Fumiyoshi Saito
  • Norio Kubo
  • Akira Watanabe
  • Takamichi Igarashi
  • Norihiro Ishii
  • Takahiro Yamanaka
  • Ken Shirabe
  • Hiroyuki Kuwano
Original Article

Abstract

Background

International consensus guidelines for intraductal papillary mucinous neoplasms (IPMNs) were revised in 2012.

Aims

We aimed to evaluate the clinical utility of each predictor in the 2006 and 2012 guidelines and validate the diagnostic value and surgical indications.

Methods

Forty-two patients with surgically resected IPMNs were included. Each predictor was applied to evaluate its diagnostic value.

Results

The 2012 guidelines had greater accuracy for invasive carcinoma than the 2006 guidelines (64.3 vs. 31.0%). Moreover, the accuracy for high-grade dysplasia was also increased (48.6 vs. 77.1%). When the main pancreatic duct (MPD) size ≥8 mm was substituted for MPD size ≥10 mm in the 2012 guidelines, the accuracy for high-grade dysplasia was 80.0%.

Conclusions

The 2012 guidelines exhibited increased diagnostic accuracy for invasive IPMN. It is important to consider surgical resection prior to invasive carcinoma, and high-risk stigmata might be a useful diagnostic criterion. Furthermore, MPD size ≥8 mm may be predictive of high-grade dysplasia.

Keywords

Intraductal papillary mucinous neoplasm IPMN Pancreas Guidelines Surgical indication 

Notes

Acknowledgments

We thank Ms. Yuki Saka and Tomoko Ubukata for their excellent assistance.

Compliance with ethical standards

Conflict of interest

There was no significant financial support for this work that could have influenced its outcome.

Ethical approval

The study was approved by the Ethics Committee of the hospital, and all clinical samples were used in accordance with institutional guidelines and the Declaration of Helsinki after obtaining signed informed consent from all participants.

Supplementary material

10620_2017_4667_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 kb)

References

  1. 1.
    Kobari M, Egawa S, Shibuya K, et al. Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg. 1999;134:1131–1136.CrossRefPubMedGoogle Scholar
  2. 2.
    Terris B, Ponsot P, Paye F, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–1377.CrossRefPubMedGoogle Scholar
  3. 3.
    Sugiyama M, Izumisato Y, Abe N, et al. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg. 2003;90:1244–1249.CrossRefPubMedGoogle Scholar
  4. 4.
    Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Goh BK, Tan DM, Ho MM, et al. Utility of the sendai consensus guidelines for branch-duct intraductal papillary mucinous neoplasms: a systematic review. J Gastrointest Surg. 2014;18:1350–1357.CrossRefPubMedGoogle Scholar
  6. 6.
    Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–197.CrossRefPubMedGoogle Scholar
  7. 7.
    Goh BK, Thng CH, Tan DM, et al. Evaluation of the Sendai and 2012 International Consensus Guidelines based on cross-sectional imaging findings performed for the initial triage of mucinous cystic lesions of the pancreas: a single institution experience with 114 surgically treated patients. Am J Surg. 2014;208:202–209.CrossRefPubMedGoogle Scholar
  8. 8.
    Mimura T, Masuda A, Matsumoto I, et al. Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas. J Clin Gastroenterol. 2010;44:e224–e229.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim KW, Park SH, Pyo J, et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg. 2014;259:72–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Roch AM, Ceppa EP, DeWitt JM, et al. International Consensus Guidelines parameters for the prediction of malignancy in intraductal papillary mucinous neoplasm are not properly weighted and are not cumulative. HPB (Oxford). 2014;16:929–935.CrossRefGoogle Scholar
  11. 11.
    Jang JY, Park T, Lee S, et al. Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms. Br J Surg. 2014;101:686–692.CrossRefPubMedGoogle Scholar
  12. 12.
    Goh BK, Lin Z, Tan DM, et al. Evaluation of the Fukuoka Consensus Guidelines for intraductal papillary mucinous neoplasms of the pancreas: results from a systematic review of 1,382 surgically resected patients. Surgery. 2015;158:1192–1202.CrossRefPubMedGoogle Scholar
  13. 13.
    Yamada S, Fujii T, Murotani K, et al. Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms. Surgery. 2016;159:878–884.CrossRefPubMedGoogle Scholar
  14. 14.
    Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. 4th ed. Lyon: International Agency for Research on Cancer; 2010.Google Scholar
  15. 15.
    Maitra A, Fukushima N, Takaori K, Hruban RH. Precursors to invasive pancreatic cancer. Adv Anat Pathol. 2005;12:81–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Goh BK, Tan YM, Cheow PC, et al. Cystic lesions of the pancreas: an appraisal of an aggressive resectional policy adopted at a single institution during 15 years. Am J Surg. 2006;192:148–154.CrossRefPubMedGoogle Scholar
  17. 17.
    Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11:913–921. (quiz e59-60).CrossRefPubMedGoogle Scholar
  18. 18.
    Poultsides GA, Reddy S, Cameron JL, et al. Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg. 2010;251:470–476.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kang MJ, Jang JY, Lee S, et al. Clinicopathological meaning of size of main-duct dilatation in intraductal papillary mucinous neoplasm of pancreas: proposal of a simplified morphological classification based on the investigation on the size of main pancreatic duct. World J Surg. 2015;39:2006–2013.CrossRefPubMedGoogle Scholar
  20. 20.
    Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med. 2015;3:286.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Mariko Tsukagoshi
    • 1
    • 2
  • Kenichiro Araki
    • 1
    • 2
  • Fumiyoshi Saito
    • 1
  • Norio Kubo
    • 1
    • 2
  • Akira Watanabe
    • 1
    • 2
  • Takamichi Igarashi
    • 2
  • Norihiro Ishii
    • 1
    • 2
  • Takahiro Yamanaka
    • 1
    • 2
  • Ken Shirabe
    • 2
  • Hiroyuki Kuwano
    • 1
  1. 1.Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
  2. 2.Department of Hepatobiliary and Pancreatic SurgeryGunma University Graduate School of MedicineMaebashiJapan

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