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Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review

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Abstract

Purpose

The aim of this study was to investigate the validity of the management strategy for intraductal papillary mucinous neoplasms (IPMNs) advocated by the international consensus guidelines 2012 (ICG2012).

Methods

The medical records of 49 patients who underwent pancreatectomy for IPMN were retrospectively reviewed.

Results

According to preoperative imaging, 10 patients (20 %) had main-duct IPMNs, 20 (41 %) had mixed IPMNs, and 19 (39 %) had branch-duct IPMNs, with malignancy frequencies of 80, 15, and 37 %, respectively. Twenty-seven patients had high-risk stigmata and 21 had worrisome features, with malignancy frequencies of 59 and 10 %, respectively. The sensitivity, specificity, and positive and negative predictive values of high-risk stigmata for malignancy were 88, 65, 59, and 91 %, respectively. Lesions were malignant in 88 % of patients with an enhanced solid component, which was significantly correlated with the prevalence of malignancy (P < 0.01). However, of the 10 patients who underwent pancreatectomy solely due to a main pancreatic dilation of ≥10 mm, 9 (90 %) had benign IPMNs.

Conclusions

Many mixed IPMNs defined according to ICG2012 are benign. Although the management strategy advocated by ICG2012 has been improved relative to the Sendai criteria, the different high-risk stigmata carry unequal weights. Consequently, ICG2012 remains suboptimal for predicting malignant IPMN.

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Authors and Affiliations

  1. Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan

    Yusuke Watanabe, Kazuyoshi Nishihara, Yuji Abe, Takao Amaike, Shin Kibe, Yusuke Mizuuchi, Toru Nakano & Shoshu Mitsuyama

  2. Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan

    Yusuke Niina

  3. Department of Radiology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan

    Daisuke Kakihara & Minoru Ono

  4. Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan

    Sadafumi Tamiya & Satoshi Toyoshima

Authors
  1. Yusuke Watanabe
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  2. Kazuyoshi Nishihara
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  3. Yusuke Niina
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  4. Yuji Abe
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  5. Takao Amaike
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  6. Shin Kibe
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  8. Daisuke Kakihara
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  9. Minoru Ono
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  10. Sadafumi Tamiya
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  11. Satoshi Toyoshima
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  12. Toru Nakano
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  13. Shoshu Mitsuyama
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Corresponding author

Correspondence to Yusuke Watanabe.

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Watanabe, Y., Nishihara, K., Niina, Y. et al. Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review. Surg Today 46, 1045–1052 (2016). https://doi.org/10.1007/s00595-015-1292-2

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  • DOI: https://doi.org/10.1007/s00595-015-1292-2

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