Introduction: The decision making in BD-IPMN is related to risk parameters reported in the 2012 guidelines. Aims: To evaluate the accuracy of parameters in predicting malignancy. Materials & methods: A systematic review was conducted to identify all studies published up to 2014 regarding treatment of BD-IPMN. Pooled diagnostic odds ratio (DOR), sensitivity (SE), specificity (SP), area under the curve (AUC) were calculated. Presence of publication bias, diagnostic threshold variation (DTV) and heterogeneity were evaluated. Results: Twenty-five papers were included (2025 patients). Jaundice, mural nodules and cytology presented the higher DOR among the parameters (6.3, 4.8 and 5.5, respectively). AUCs were poor for jaundice and cytology (0.189 and 0.438, respectively) and moderate for mural nodules (0.777). Jaundice presented the highest SP (97 %) while mural nodules the best SE (53 %). Among “worrisome features”, thickened wall and main pancreatic duct (MPD) dilatation (5-9mm) had the better DORs (4.2 and 4.0, respectively) with moderate AUCs (0.714 for both). Cyst size cut-off of 30 mm and pancreatitis presented a low DORs (2.3 and 2.1) with a low (0.605) and poor (0.456) accuracy. Pancreatitis had the best SP (92.1%) while MPD dilatation had the best SE (57.2%). Only MPD dilatation and thickened wall did not present DTV. Heterogeneity were high for cyst size, mural nodules and cytology. Conclusion: All “high risk stigmata” were more frequently related to malignancy than “worrisome features”. Mural nodules resulted the best parameters in predicting malignancy. Among “worrisome features”, MPD dilatation and thickened wall had the best accuracy.
Branch duct intraductal papillary mucinous neoplasm: validation of Fukuoka 2012 guidelines using a systematic review and meta-analysis
DE GIORGIO, Roberto;
2015
Abstract
Introduction: The decision making in BD-IPMN is related to risk parameters reported in the 2012 guidelines. Aims: To evaluate the accuracy of parameters in predicting malignancy. Materials & methods: A systematic review was conducted to identify all studies published up to 2014 regarding treatment of BD-IPMN. Pooled diagnostic odds ratio (DOR), sensitivity (SE), specificity (SP), area under the curve (AUC) were calculated. Presence of publication bias, diagnostic threshold variation (DTV) and heterogeneity were evaluated. Results: Twenty-five papers were included (2025 patients). Jaundice, mural nodules and cytology presented the higher DOR among the parameters (6.3, 4.8 and 5.5, respectively). AUCs were poor for jaundice and cytology (0.189 and 0.438, respectively) and moderate for mural nodules (0.777). Jaundice presented the highest SP (97 %) while mural nodules the best SE (53 %). Among “worrisome features”, thickened wall and main pancreatic duct (MPD) dilatation (5-9mm) had the better DORs (4.2 and 4.0, respectively) with moderate AUCs (0.714 for both). Cyst size cut-off of 30 mm and pancreatitis presented a low DORs (2.3 and 2.1) with a low (0.605) and poor (0.456) accuracy. Pancreatitis had the best SP (92.1%) while MPD dilatation had the best SE (57.2%). Only MPD dilatation and thickened wall did not present DTV. Heterogeneity were high for cyst size, mural nodules and cytology. Conclusion: All “high risk stigmata” were more frequently related to malignancy than “worrisome features”. Mural nodules resulted the best parameters in predicting malignancy. Among “worrisome features”, MPD dilatation and thickened wall had the best accuracy.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
