Abstract
The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neoplasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 patients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy.
Highlights
First described in 1824, pancreatic cystic lesions are nowadays common incidental findings on routine cross-sectional imaging owing to improvements in imaging techniques, the widespread use of various imaging modalities, and the established trend of preventive health check-ups [1]
Among the 106 patients included in the study, 68 had intraductal papillary mucinous neoplasm (IPMN) diagnosis, mucinous cystic neoplasms (MCN) 14, serous cystic neoplasms (SCN) 17, solid pseudopapillary neoplasms (SPN) five, and cystic neuroendocrine tumors (cNET) two
It should be noted that the risk of advanced neoplasia in resected IPMN patients has a mean frequency of 62% which is the highest among other pancreatic cystic neoplasm (PCN) [5]
Summary
First described in 1824, pancreatic cystic lesions are nowadays common incidental findings on routine cross-sectional imaging owing to improvements in imaging techniques, the widespread use of various imaging modalities, and the established trend of preventive health check-ups [1]. As a heterogeneous group of pancreatic cysts, pancreatic cystic neoplasms (PCNs) include intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), and other rare cystic lesions such as solid pseudopapillary neoplasms (SPNs), and cystic neuroendocrine tumors (cNETs), diverging in clinical, radiological, and pathological features. Special emphasis should be placed on IPMNs since this is the premalignant type of PCN with the highest frequency of the risk of advanced neoplasia in resected patients among. PCNs and requires either surveillance or in some cases, surgical resection [3,4,5]. It is characterized by papillary growths within the pancreatic ductal system with thick mucin secretion with the present risk of undergoing malignant transformation [6]. The true incidence of IPMNs is unknown since most of them are small and asymptomatic
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