• Annals of surgery · Sep 2024

    Diagnostic Performance of Surgical Indication for Branch-duct or Mixed-type Intraductal Papillary Mucinous Neoplasms of the Revised International Association of Pancreatology (IAP) 2023 Guidelines.

    • Hye-Sol Jung, Youngmin Han, Yoon Soo Chae, Won-Gun Yun, Young Jae Cho, Younsoo Seo, Go Won Choi, Haeryoung Kim, Kyoung Bun Lee, Dong Ho Lee, Wooil Kwon, Joon Seong Park, and Jin-Young Jang.
    • Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (Jung, Han, Chae, Yun, Cho, Seo, Choi, Kwon, Park, Jang).
    • Ann. Surg. 2024 Sep 11.

    ObjectiveTo evaluate the diagnostic performance of surgical indications of the revised International Association of Pancreatology (IAP) 2023 guidelines compared to the IAP 2017 and European 2018 guidelines.Summary Background DataThe revised IAP guidelines for surgical indications for branch duct (BD) intraductal papillary mucinous neoplasms (IPMN) include the presence of at least two worrisome features without mandatory endoscopic ultrasound.MethodsAmong 663 patients who underwent resection for pathologically confirmed IPMN in a tertiary hospital between 2013 and 2023, 556 patients with BD or mixed-type IPMN were retrospectively reviewed. Diagnostic performances of the three guidelines for predicting high-grade dysplasia or IPMN with invasive carcinoma were compared. The primary outcome was the malignancy rate. Clinicopathological and radiological imaging data were analyzed.ResultsA total of 540, 451, and 490 patients met the surgical indications of the IAP, 2017, 2023, and European guidelines, respectively. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia, n=99; invasive carcinoma, n=130). Surgical indication by the IAP 2023 guidelines showed higher specificity (29.1 vs. 4.9%, P<0.001), positive predictive value (48.6 vs. 42.4%, P=0.031), and accuracy (55.5 vs. 44.1%, P<0.001) than the IAP 2017 guidelines. It also had higher specificity than the European guidelines (18.7%, P=0.024). The IAP 2023 guidelines showed a superior AUC of surgical indication (0.623 vs. 0.582 for the European guidelines, P<0.001; and 0.524 for the IAP guidelines, P=0.008).ConclusionsThe IAP 2023 guidelines showed better malignancy prediction than the IAP 2017 and European guidelines, potentially reducing unnecessary surgeries.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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