Purpose A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. Methods An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. Results A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. Conclusion Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
Resumen
Las metástasis en vesícula biliar (VB) de los melanomas malignos (MM) son muy infrecuentes. Mujer de 68 años, diagnosticada en 2012 por un melanoma en coana derecha (B-RAF y C-kit negativos), tratada con cirugía y nivolumab. En abril de 2016 se realiza colecistectomía por metástasis en vesícula biliar. Presenta progresión de la enfermedad y fallece veinticuatro meses después, una de las supervivencias más largas publicadas. Las MM de VB suelen ser asintomáticas, se diagnostican por ecografía o tomografía en el contexto de enfermedad diseminada y deben ser intervenidas quirúrgicamente, pues mejora la supervivencia y la calidad de vida.
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