Risk of malignancy in resected pancreatic mucinous cystic neoplasms

Keane, M. G.; Shamali, Awad; Nilsson, Linda; Antila, Anne; Bocos, Judith Millastre; Zanten, Monica Marijinissen Van; Gil, Cristina Verdejo; Maisonneuve, Patrick; Vaalavuo, Yrjö; Hoskins, Toby; Robinson, Stuart; Ceyhan, Güralp O.; Hilal, Mohammed Abu; Pereira, Stephen P.; Laukkarinen, Johanna; Chiaro, Marco Del

doi:10.1002/bjs.10787

Cited by 37 publications

(22 citation statements)

References 27 publications

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“…However, difference did not reach statistical significance (P=0.085). Association of weight loss and invasive carcinoma has been shown in multiple studies before (11,17,24). Correlation with malignancy was also present in our study (P=0.01).…”

Section: Etiological and Clinical Findings Associated With Malignancysupporting

confidence: 86%

“…Unfortunately, we cannot provide a definitive explanation for the high overall proportion of men in our study. Multiple studies found that symptoms like weight loss, back pain and jaundice in patients undergoing surgery for MCN were associated with malignancy (23,24). In our study pain was more frequent in patients with invasive disease.…”

Section: Etiological and Clinical Findings Associated With Malignancysupporting

confidence: 57%

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It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

Höhn¹,

Soydemir²,

Luu³

et al. 2020

Ann Transl Med

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Background: Mucinous cystic neoplasms (MCN) of the pancreas are rare mucin-producing cystic tumors. As they harbor malignant potential, surgical resection is frequently performed. Current guidelines recommend surgery in asymptomatic patients only for MCN exceeding 4 cm. The aim of this study was to identify radiological and clinical risk factors for malignancy in a single-center cohort of MCN.Methods: All resected MCN from a single high-volume center between 2004 and 2019 were retrospectively analyzed. Patient characteristics, preoperative findings, histopathological results, and data on the postoperative course were recorded. Variables associated with malignancy were evaluated using χ 2 and Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to model predictive capabilities of preoperative tumor marker levels. Furthermore uni-and multivariate logistic regression analysis were performed for binary variables. Survival time was plotted as Kaplan-Meier curves and evaluated by log-rank test.Results: A total of 63 patients were included. Median age was 62 years; 51 (81.0%) of them were women; median tumor size was 3.5 cm (range, 0.5-18.5); 16 (25.4%) of tumors harbored invasive carcinoma and 13 presented intraepithelial dysplasia (20.6%); 7 (43.8%) invasive carcinomas were smaller than 4 cm. All malignant MCN were radiologically suspected of malignancy (calcifications, mural nodules, or wall thickness) preoperatively. Elevated levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were strongly associated with malignancy (odd's ratio 33.600; 7.000-161.270); P<0.001 and odd's ratio 19.250; 3.370-109.970; P<0.001). Other factors associated with malignancy were preoperative weight loss (P=0.015) and higher age (P=0.048). Tumor size, abdominal or back pain or jaundice showed no significant correlation to malignancy in our cohort.Conclusions: Malignant potential of MCN should not be underestimated and a close clinical and radiological follow-up is mandatory in all suspected cases. This is especially important for small lesions. Risk assessment should not rely only on tumor size but consider all clinical, radiological and laboratory findings of each case. Follow-up should be performed by experienced surgeons and radiologists in high volume centers for pancreatic surgery. Surgery should be performed in all cases in which malignancy is suspected.

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Section: Etiological and Clinical Findings Associated With Malignancysupporting

confidence: 86%

Section: Etiological and Clinical Findings Associated With Malignancysupporting

confidence: 57%

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

Höhn¹,

Soydemir²,

Luu³

et al. 2020

Ann Transl Med

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“…Recent studies on MCNs have shown that the risk of cancer in cysts less than 40 mm in size and without worrisome features is exceedingly rare [84,118]; therefore, in contrast to other guidelines, the revised European guidelines recommends surveillance of all MCNs <40 mm, following the same surveillance intervals as for a BD IPMN [57].…”

Section: Surveillancementioning

confidence: 99%

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Keane

Afghani

2021

JCM

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Pancreatic cystic lesions are an increasingly common clinical finding. They represent a heterogeneous group of lesions that include two of the three known precursors of pancreatic cancer, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Given that approximately 8% of pancreatic cancers arise from these lesions, careful surveillance and timely surgery offers an opportunity for early curative resection in a disease with a dismal prognosis. This review summarizes the current evidence and guidelines for the diagnosis and management of IPMN/MCN. Current pre-operative diagnostic tests in pancreatic cysts are imperfect and a proportion of patients continue to undergo unnecessary surgical resection annually. Balancing cancer prevention while preventing surgical overtreatment, continues to be challenging when managing pancreatic cysts. Cyst fluid molecular markers, such as KRAS, GNAS, VHL, PIK3CA, SMAD4 and TP53, as well as emerging endoscopic technologies such as needle-based confocal laser endomicroscopy and through the needle microbiopsy forceps demonstrate improved diagnostic accuracy. Differences in management and areas of uncertainty between the guidelines are also discussed, including indications for surgery, surveillance protocols and if and when surveillance can be discontinued.

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“…Of these cystic lesions, pancreatic cystic neoplasm (PCN) management is challenging and important in modern pancreatology. The challenge lies in the difficulty in accurately discerning completely benign PCNs from ones with potential for malignancy progression [ 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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Intraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study tests the diagnostic value of the main pancreatic duct (MPD) diameter for detecting IPMN malignancy using a meta-analysis of published data of resected IPMNs. Collected from a comprehensive literature search, the articles included in this analysis must report malignancy cases (high-grade dysplasia (HGD) and invasive carcinoma (IC)) and MPD diameter so that two MPD cut-offs could be created. The sensitivity, specificity, and odds ratios of the two cutoffs for predicting malignancy were calculated. A review of 1493 articles yielded 20 retrospective studies with 3982 resected cases. A cutoff of ≥5 mm is more sensitive than the ≥10 mm cutoff and has pooled sensitivity of 72.20% and 75.60% for classification of HGD and IC, respectively. Both MPD cutoffs of ≥5 mm and ≥10 mm were associated with malignancy (OR = 4.36 (95% CI: 2.82, 6.75) vs. OR = 3.18 (95% CI: 2.25, 4.49), respectively). The odds of HGD and IC for patients with MPD ≥5 mm were 5.66 (95% CI: 3.02, 10.62) and 7.40 (95% CI: 4.95, 11.06), respectively. OR of HGD and IC for MPD ≥10 mm cutoff were 4.36 (95% CI: 3.20, 5.93) and 4.75 (95% CI: 2.39, 9.45), respectively. IPMN with MPD of >5 mm could very likely be malignant. In selected IPMN patients, pancreatectomy should be considered when MPD is >5 mm.

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Risk of malignancy in resected pancreatic mucinous cystic neoplasms

Abstract: Small indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.

Cited by 37 publications

References 27 publications

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

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