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Review
. 2021 Apr 22;13(9):2031.
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

Y H Andrew Wu  1 , Atsushi Oba  1   2 , Laurel Beaty  1   3 , Kathryn L Colborn  1   3   4 , Salvador Rodriguez Franco  1   5 , Ben Harnke  6 , Cheryl Meguid  1 , Daniel Negrini  1   7 , Roberto Valente  1   8 , Steven Ahrendt  1   9 , Richard D Schulick  1   9 , Marco Del Chiaro  1   9
Affiliations
Review

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 et al. Cancers (Basel). .

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.

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Conflict of interest statement

None of the authors have any personal conflict of interest to declare, except for Del Chiaro who is a co-principal investigator on a Boston Scientific study investigating the role of intraoperative pancreatoscopy in IPMN patients. Del Chiaro has also been awarded an industry grant from Haemonetics Inc. to conduct a multicenter study that evaluates the prognostic implications and changes of thromboelastographic (TEG) in pancreas cancer patients.

Figures

Figure 1
Figure 1
PRISMA flow chart showing the article selection process.
Figure 2
Figure 2
Meta-analysis forest plot presented in Diagnostic Odds Ratio (OR): (A) malignancy (M) and non-malignancy (NM), cutoff of 5 mm; (B) malignancy (M) and non-malignancy (NM), cutoff of 10 mm; (C) high-grade dysplasia (HGD) and non-malignancy (NM), cutoff of 5 mm; (D) high-grade dysplasia (HGD) and non-malignancy (NM), cutoff of 10 mm; (E) invasive carcinoma (IC) vs. non-malignancy (NM), cutoff of 5 mm; (F) invasive carcinoma (IC) vs. non-malignancy (NM), cutoff of 10 mm.
Figure 3
Figure 3
Summary receiver operating characteristic (SROC) curves for the bivariate diagnostic tests. Dot is point estimate that represents estimated pooled sensitivity/1-specificity for the included studies. Circle represents the confidence interval around the point estimate.
See this image and copyright information in PMC

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