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A tug-of-war in int...
A tug-of-war in intraductal papillary mucinous neoplasms management : Comparison between 2017 International and 2018 European guidelines
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Crippa, Stefano (author)
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Fogliati, Alessandro (author)
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- Valente, Roberto (author)
- HPB Diseases Unit, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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- Sadr-Azodi, Omid (author)
- Karolinska Institutet
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- Arnelo, Urban (author)
- Karolinska Institutet
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Capurso, Gabriele (author)
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Halimi, Asif (author)
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Partelli, Stefano (author)
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- Ateeb, Zeeshan (author)
- Karolinska Institutet
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Arcidiacono, Paolo Giorgio (author)
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- Lohr, J. Matthias (author)
- Karolinska Institutet
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Falconi, Massimo (author)
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Del Chiaro, Marco (author)
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(creator_code:org_t)
- Elsevier, 2021
- 2021
- English.
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In: Digestive and Liver Disease. - : Elsevier. - 1590-8658 .- 1878-3562. ; 53:8, s. 998-1003
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Abstract
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- BACKGROUND: 2017 International and 2018 European guidelines are the most recent guidelines for intraductal papillary mucinous neoplasms management.AIM: to evaluate the diagnostic accuracy of these guidelines in identifying malignant IPMN.METHODS: data from resected patients with IPMN were collected in two referral centers. Features of risk associated to cancerous degeneration described in International and European guidelines were retrospectively applied. Sensitivity, specificity, positive and negative predictive value in detecting malignant disease were calculated.RESULTS: the study includes 627 resected patients. European guidelines suggest resection in any patient with at least one feature of moderate-risk. International guidelines suggest that patients with moderate-risk features undergo endoscopic ultrasound before surgery. European guidelines had a higher sensitivity (99.2% vs. 83%) but a lower positive predictive value (59.5% vs. 65.8%) and Specificity (2% vs. 37.5%). European guidelines detected almost all malignancies, but 40% of resected patients had low-grade dysplasia. 297 patients underwent endoscopic ultrasound before surgery. 31/116 (26.7%) tumors radiologically classified as "worrisome features" were reclassified as "high-risk stigmata" by endoscopic ultrasound and 24/31 were malignant IPMN.CONCLUSIONS: European and International guidelines have a relatively low diagnostic accuracy, being European guidelines more aggressive. Endoscopic ultrasound can improve guidelines accuracy in patients with moderate-risk features.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Keyword
- Endoscopic ultrasound
- Guidelines
- Intraductal papillary mucinous neoplasms
- Pancreatic cancer
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Crippa, Stefano
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Fogliati, Alessa ...
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Valente, Roberto
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Sadr-Azodi, Omid
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Arnelo, Urban
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Capurso, Gabriel ...
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show more...
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Halimi, Asif
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Partelli, Stefan ...
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Ateeb, Zeeshan
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Arcidiacono, Pao ...
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Lohr, J. Matthia ...
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Falconi, Massimo
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Del Chiaro, Marc ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Gastroenterology ...
- Articles in the publication
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Digestive and Li ...
- By the university
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Umeå University
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Uppsala University
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Karolinska Institutet