Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms

Xu, Mingming; Yin, Shan; Siddiqui, Ali A.; Salem, Ronald R.; Schrope, Beth; Sethi, Amrita; Poneros, John M.; Gress, Frank G.; Genkinger, Jeanine M.; Do, Catherine; Brooks, Christian; Chabot, John A.; Kluger, Michael D.; Kowalski, Thomas E.; Loren, David E.; Aslanian, Harry R.; Farrell, James J.; Gonda, Tamas A.

doi:10.1097/md.0000000000007900

Cited by 62 publications

(60 citation statements)

References 20 publications

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“…A retrospective study of patients from three centres found that only 7.3% of patients with advanced neoplasia fulfilled the AGA criteria for surgical resection, in contrast to 73.1% who satisfied the Fukuoka guideline criteria for resection. 24 Singhi et al published a study applying the AGA guidelines retrospectively to 225 patients and demonstrated that for the ability to detect advanced neoplasia, the AGA guidelines had a sensitivity of only 62%, with a specificity of 79% and a PPV of 57%. 25 Furthermore, the guidelines failed to pick up 45% of IPMN patients with adenocarcinoma or high-grade dysplasia.…”

Section: Guidelinesmentioning

confidence: 99%

Diagnostic approaches for pancreatic cystic lesions

Kanani

Isherwood

Chung

et al. 2020

ANZ Journal of Surgery

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Background: Cystic lesions of the pancreas (PCLs) may be inflammatory or proliferative and making an accurate and timely pre-operative diagnosis remains a significant clinical challenge. This is principally due to the heterogeneity of the pathological processes involved. PCLs constitute an entity with diverse histology and although infrequent, the possible potential for malignant transformation of these lesions and the opportunity for curative surgery mandates that our diagnostic approaches are up to date and evidence based. In addition, improved diagnostic accuracy is crucial to prevent unnecessary surgical procedures with the inevitable associated morbidity. Methods: This narrative review examines the current diagnostic benchmarks and identifies novel diagnostic techniques that warrant further consideration, a number of which are beginning to be included in routine clinical practice when these PCLs are being investigated. A computerized search was made of MEDLINE, EMBASE and PubMed using the search words 'diagnostic approaches to pancreatic cystic lesions'. All relevant articles in English language or with an English abstract were retrieved and additionally cross referenced. Conclusion: The increasing accuracy of available imaging techniques together with the wider availability of endoluminal ultrasound and the development of additional novel methods to assess PCLs presents an opportunity to significantly improve the pre-operative diagnosis rate. This is essential to classify the type of PCL and hence guide the management particularly with lesions where there is a likelihood of progression to more serious pathology. We have highlighted the need for a comprehensive and standardized algorithm for the diagnosis and management of PCLs.

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Section: Guidelinesmentioning

confidence: 99%

Diagnostic approaches for pancreatic cystic lesions

Kanani

Isherwood

Chung

et al. 2020

ANZ Journal of Surgery

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“…IPMNs with "worrisome features" and endoscopic ultrasound (EUS) with negative findings should have imaging and EUS surveillance based on cyst size [13]. In secondary analyses, the specificity of the Fukuoka guidelines reaches 94%-97% in some studies, with sensitivity only reaching 28%-62% [14,15] The American Gastroenterological Association (AGA) guidelines for pancreatic cysts also define "high-risk" lesion characteristics as a size ≥3 cm, a dilated MPD, and mural nodules [16]. For high risk lesions, EUS with a fine needle aspiration (FNA) of cyst fluid is recommended for further analysis, which then informs the decision to observe or resect.…”

Section: Introductionmentioning

confidence: 99%

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

Hao

Takahashi

Snyder

et al. 2020

IJMS

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A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.

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“…Intraductal papillary mucinous neoplasm (IPMN) constitutes a broad pathological spectrum: hyperplasia (benign), low-grade dysplasia (adenoma), high-grade dysplasia (carcinoma in situ), and adenocarcinoma [ 1 ]. Even though 2 guidelines have proposed the use of several key imaging features (e.g., mural nodule, dilated pancreatic duct) for risk stratification of malignancy, the diagnostic yield of these criteria requires further improvement [ 2 – 4 ]. Therefore, a considerable number of studies utilizing imaging studies, cytology, and cystic fluid analysis (for tumor markers, molecular markers, etc.)…”

Section: Introductionmentioning

confidence: 99%

Prognostic influence of endoscopic ultrasound-guided fine needle aspiration in IPMN-derived invasive adenocarcinoma

et al. 2018

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BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for mucinous cystic neoplasm of the pancreas carries a potential risk of inducing peritoneal tumor cell dissemination. We investigated the diagnostic yield and safety of EUS-FNA-based cytology of cells obtained from the pancreatic invasion site of intraductal papillary-mucinous neoplasm-derived adenocarcinoma (IPMC).MethodsWe included 22 surgically resected IPMCs and 84 pancreatic ductal adenocarcinomas (PDACs). Among the IPMC cases, 14 did not undergo EUS-FNA before surgical resection. The diagnostic yield of EUS-FNA was compared between IPMC and PDAC. Additionally, prognosis (relapse-free and overall survival time after resection) and the rate of peritoneal dissemination were compared among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC. A survival analysis was performed using the Kaplan-Meier method and log-rank test.Results(EUS-FNA diagnosis) There were no significant differences in the number of needle passages (PDAC 2.5 vs. IPMC 2.0 passages, P = 0.84) or puncture route (stomach/duodenum: 2/6 vs. 45/39, P = 0.29). However, the correct diagnosis rate was significantly higher in PDAC (92.9%) than in IPMC (62.5%) (P = 0.03). No procedure-related adverse events occurred. Peritoneal lavage cytology performed during the operation was negative in all cases. (Prognosis) Among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC, there were no significant differences in relapse-free survival (21.0 vs. 22.4 vs. 12.5 months, respectively; P = 0.64) or overall survival time (35.5 vs. 53.1 vs. 35.9 months, respectively; P = 0.42), and peritoneal dissemination was detected during the observation period in 25%, 28.5%, and 21.4% cases, respectively (P = 0.82).ConclusionEven though a correct diagnosis was more difficult to obtain in IPMC than in PDAC, IPMC allows specimens to be obtained without influencing the rate of recurrence and prognosis.

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Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms

Abstract: Supplemental Digital Content is available in the text

Cited by 62 publications

References 20 publications

Diagnostic approaches for pancreatic cystic lesions

Diagnostic approaches for pancreatic cystic lesions

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

Prognostic influence of endoscopic ultrasound-guided fine needle aspiration in IPMN-derived invasive adenocarcinoma

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