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.

Y.H Andrew Wu,Salvador Rodriguez Franco,Laurel Beaty,Richard D Schulick,Ben Harnke,Steven Ahrendt,Marco Del Chiaro,Cheryl Meguid,Daniel Negrini,Roberto Valente,Atsushi Oba,Kathryn L Colborn

doi:10.3390/cancers13092031

Abstract

Simple SummaryIntraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study evaluates the diagnostic value of main pancreatic duct (MPD) diameter for detecting IPMN malignancy, using a meta-analysis of published data. The result suggests that malignancy is highly prevalent in IPMN with ductal dilatation of >5 mm.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.

Highlights

We evaluated the association between cutoffs of ≥5 mm and ≥10 mm and classification of high-grade dysplasia (HGD), invasive carcinoma (IC), and malignancy
The authors excluded one hundred manuscripts for the following reasons: 41 articles did not have main pancreatic duct (MPD) dilatation values; 37 articles did not have all the MPD ranges that adhered to our criteria; 8 articles had incorrect study design and did not include information needed for quantitative meta-analysis; 5 articles had vague or no histology diagnosis; articles did not provide sufficient information for case number retrieval; 2 articles only used ultrasound/endoscopic ultrasound for preoperative evaluation; 1 article lacked surgical pathology results; 1 article had duplication of cohort with another included article (Figure 1)
Including only pathologically confirmed Intraductal papillary mucinous neoplasms (IPMN) cases for analysis, this study shows that many HGD and IC patients would be missed if the decision to operate were made at MPD ≥ 10 mm associated with low sensitivity

Summary

Introduction

The prevalence of these lesions is around 50% in the general population and increases with age [1]. Of these cystic lesions, pancreatic cystic neoplasm (PCN) management is challenging and important in modern pancreatology. The morphologic and radiologic classification for identifying BD-IPMN, MD-IPMN, or mixed-type IPMN is extremely important. It is well known that BD-IPMNs have a very low risk for cancer progression; in contrast, MD- and mixed-type IPMNs are more prone to becoming cancerous [2,8]. IPMNs involving the MPDs are more aggressive and generally need to be treated surgically [6,11]

Results

Discussion

Conclusion