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; Atsushi Oba; Laurel Beaty; Kathryn L Colborn; Salvador Rodriguez Franco; Ben Harnke; Cheryl Meguid; Daniel Negrini; Roberto Valente; Steven Ahrendt; Richard D Schulick; Marco Del Chiaro

doi:10.3390/cancers13092031

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

Cancers (Basel). 2021 Apr 22;13(9):2031. doi: 10.3390/cancers13092031.

Authors

Y H Andrew Wu¹, Atsushi Oba^{1

2}, Laurel Beaty^{1

3}, Kathryn L Colborn^{1

3

4}, Salvador Rodriguez Franco^{1

5}, Ben Harnke⁶, Cheryl Meguid¹, Daniel Negrini^{1

7}, Roberto Valente^{1

8}, Steven Ahrendt^{1

9}, Richard D Schulick^{1

9}, Marco Del Chiaro^{1

9}

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
² Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 135-8550 Tokyo, Japan.
³ Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
⁴ Surgical Outcomes and Applied Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
⁵ The Heart Institute, Children's Hospital Colorado, Aurora, CO 80045, USA.
⁶ Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
⁷ Department of Anesthesiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
⁸ Department of Surgery and Perioperative Sciences, Umeå University Hospital, 907 37 Umeå, Sweden.
⁹ University of Colorado Cancer Center, Aurora, CO 80045, USA.

Abstract

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.

Keywords: high grade dysplasia; intraductal papillary mucinous neoplasm; invasive carcinoma; meta-analysis; pancreatic cancer; pancreatic cystic neoplasm; pancreatic main duct dilatation.

Publication types

Review