Intraductal Papillary Mucinous Neoplasms: Have IAP Consensus Guidelines Changed our Approach?

Abstract

Supplemental Digital Content is available in the text

Supplemental 18F-FDG-PET/CT for Detection of Malignant Transformation of IPMN—A Model-Based Cost-Effectiveness Analysis

“…The management of IPMN has continuously been in the focus of scientific debate, and international guidelines have repeatedly been revised over the last years [1,44,46]. Improvements in image quality and increasing number of imaging examinations contribute to higher detection rates of IPMN, which consequently resulted in growing numbers of IPMN resections [5,20,47]. At the same time, the limited diagnostic accuracy of current diagnostic modalities for the identification of HGD or invasive cancer in IPMN, that defines further therapeutic management, has been recognized [5,47].…”

“…Improvements in image quality and increasing number of imaging examinations contribute to higher detection rates of IPMN, which consequently resulted in growing numbers of IPMN resections [5,20,47]. At the same time, the limited diagnostic accuracy of current diagnostic modalities for the identification of HGD or invasive cancer in IPMN, that defines further therapeutic management, has been recognized [5,47]. Recent multi-center studies indicated a significant inter-institutional variance of diagnostic performance and available studies investigating the accuracy of current guidelines for the detection of HGD and invasive cancer in IPMN point towards a risk for surgical overtreatment in correlation to the histopathological results of malignancy [12,14].…”

“…Both techniques present a limited level of diagnostic accuracy for the early identification of HGD and invasive cancer in IPMN [11,15]. Pulvirenti et al demonstrated in their retrospective multi-center study that the number of BD-IPMN resected due to high-risk radiographic features increased following the introduction of the new Fukuoka guidelines 2012, while the rate of high-risk disease among resected IPMN decreased [47]. The review of the current literature together with the significant morbidity and mortality of pancreatic surgery underlines the urgent need for improved diagnostic accuracy of imaging for the sensitive and specific detection of HGD and invasive cancer in IPMN, with particular focus on cost-effectiveness of the employed diagnostic techniques.…”

Clinical Management of Pancreatic Premalignant Lesions

“…One should consider that most of the malignancy estimates stem from resected series at tertiary centers with some lag time in reporting (and based on institutional practice at the time of resection) and, hence, have a selection bias incurred. 14 Thus, there is a risk for both over-and undertreatment with any management strategy, which needs to be considered by the clinician as well as the patient.…”

Carbohydrate Antigen 125 Supplements Carbohydrate Antigen 19-9 for the Prediction of Invasive Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…Over the past decades, IPMNs have had an increasing incidence and constitute the largest proportion of pancreatic cystic lesions 2,4 . Incidentally diagnosed IPMNs account for many pancreatic surgeries, but controversy remains since the proportion of malignant IPMNs according to postoperative histology in all resected IPMNs is decreasing 5 . The e cacy of radiological examination is unsatisfactory; therefore, to accurately perform surgical resection on invasive IPMNs while avoiding unnecessary surgery, there is a clinical need to nd sensitive and speci c preoperative indications to assess the necessity of surgery 6 .…”