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; Jin-Young Jang

doi:10.1097/SLA.0000000000006530

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

Ann Surg. 2024 Sep 11. doi: 10.1097/SLA.0000000000006530. Online ahead of print.

Authors

Affiliations

¹ 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).
² Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea (Kim and K.B.L.).
³ Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea (D.H.L).

PMID: 39258374
DOI: 10.1097/SLA.0000000000006530

Abstract

Objective: To 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 data: The 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.

Methods: Among 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.

Results: A 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).

Conclusions: The IAP 2023 guidelines showed better malignancy prediction than the IAP 2017 and European guidelines, potentially reducing unnecessary surgeries.