Goh Brian K P, Tan Damien M Y, Ho Mac M F, Lim Tony K H, Chung Alexander Y F, Ooi London L P J
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, 20 College Road, Academia, 169856, Singapore,
J Gastrointest Surg. 2014 Jul;18(7):1350-7. doi: 10.1007/s11605-014-2510-8. Epub 2014 Mar 26.
The Sendai Consensus Guidelines (SCG) was formulated in 2006 to guide the management of intraductal papillary mucinous neoplasms (IPMN). The main area of controversy is the criteria for selection of branch duct (BD)-IPMN for resection. Although these guidelines have gained widespread acceptance, there is limited data to date supporting its use. This systematic review is performed to evaluate the utility of the Sendai Consensus Guidelines (SCG) for BD-IPMN.
Studies evaluating the clinical utility of the SCG in surgically resected neoplasms were identified. The SCG were retrospectively applied to all resected neoplasms in these studies. BD-IPMNs which met the criteria for resection were termed SCG+ve and those for surveillance were termed SCG-ve.
Twelve studies were included, of which, 9 were suitable for pooled analysis. There were 690 surgically resected BD-IPMNs, of which, 24% were malignant. Five hundred one BD-IPMNs were classified as SCG+ve and 189 were SCG-ve. The positive predictive value (PPV) of SCG+ve neoplasms ranged from 11 to 52% and the NPV of SCG-ve neoplasms ranged from 90 to 100%. Overall, there were 150/501 (29.9%) of malignant BD-IPMNs in the SCG+ve group and 171/189 (90%) of benign BD-IPMNs in the SCG-ve group. Of the 18 reported malignant (11 invasive) BD-IPMNs in the SCG-ve group, 17 (including all 11 invasive) were from a single study. When the results from this single study were excluded, 170/171 (99%) of SCG-ve BD-IPMNs were benign.
The results of this review confirm the limitations of the SCG for BD-IPMN. The PPV of the SCG in predicting a malignant BD-IPMN was low and some malignant lesions may be missed based on these guidelines.
《仙台共识指南》（SCG）于2006年制定，用于指导导管内乳头状黏液性肿瘤（IPMN）的管理。主要争议领域是选择分支导管（BD）-IPMN进行切除的标准。尽管这些指南已获得广泛认可，但迄今为止支持其使用的数据有限。本系统评价旨在评估《仙台共识指南》（SCG）对BD-IPMN的实用性。
确定评估SCG在手术切除肿瘤中的临床实用性的研究。SCG被回顾性应用于这些研究中的所有切除肿瘤。符合切除标准的BD-IPMN被称为SCG阳性，而进行监测的则被称为SCG阴性。
纳入12项研究，其中9项适合进行汇总分析。有690例手术切除的BD-IPMN，其中24%为恶性。501例BD-IPMN被分类为SCG阳性，189例为SCG阴性。SCG阳性肿瘤的阳性预测值（PPV）范围为11%至52%，SCG阴性肿瘤的阴性预测值（NPV）范围为90%至100%。总体而言，SCG阳性组中有150/501（29.9%）的恶性BD-IPMN，SCG阴性组中有171/189（90%）的良性BD-IPMN。在SCG阴性组报告的18例恶性（11例浸润性）BD-IPMN中，17例（包括所有11例浸润性）来自单一研究。排除该单一研究的结果后，170/171（99%）的SCG阴性BD-IPMN为良性。
本评价结果证实了SCG对BD-IPMN的局限性。SCG预测恶性BD-IPMN的PPV较低，基于这些指南可能会遗漏一些恶性病变。
