Ge Phillip S, Muthusamy V Raman, Gaddam Srinivas, Jaiyeola Diana-Marie, Kim Stephen, Sedarat Alireza, Donahue Timothy R, Hosford Lindsay, Wilson Robert H, Grande David P, Keswani Rajesh N, Kushnir Vladimir M, Mullady Daniel, Edmundowicz Steven A, Early Dayna S, Komanduri Srinadh, Wani Sachin, Watson Rabindra R
Division of Digestive Diseases and Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States.
Endosc Int Open. 2017 Mar;5(3):E201-E208. doi: 10.1055/s-0042-122010.
The American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs. A retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 - 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated. Three hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 - 92.1), 69.1 % specificity (95 % CI 62.9 - 74.8), 37.2 % positive predictive value (95 % CI 28.6 - 46.4), 95.0 % negative predictive value (95 % CI 90.7 - 97.7), and 71.7 % accuracy (95 % CI 67.4 - 74.6). The 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines. Meeting presentations: Presented in part at Digestive Diseases Week 2016.
美国胃肠病学会（AGA）最近发布了无症状胰腺囊性肿瘤（PCN）的管理指南。我们旨在评估AGA指南在合理推荐恶性PCN手术方面的诊断特征。对2004年至2014年间因评估PCN而接受内镜超声（EUS）检查并最终接受手术切除的患者进行了一项回顾性多中心研究。记录了患者的人口统计学资料、EUS特征、细针穿刺（FNA）结果、切除类型和最终病理诊断。根据AGA指南的建议，将患者分为两组（手术组或监测组）。计算了手术病理诊断癌症或高级别上皮内瘤变（HGD）的性能特征。300例患者因PCN接受了手术切除，其中AGA指南建议手术治疗的有121例（40.3%），建议监测的有179例（59.7%）。在建议手术治疗的患者中，45例（37.2%）患有癌症，而76例（62.8%）没有癌症/HGD。在建议监测的患者中，170例（95.0%）没有癌症/HGD；然而，9例（5.0%）患者患有癌症，而这些癌症本可能被漏诊。对于手术病理发现癌症/HGD，AGA指南的敏感性为83.3%（95%CI 70.7 - 92.1），特异性为69.1%（95%CI 62.9 - 74.8），阳性预测值为37.2%（95%CI 28.6 - 46.4），阴性预测值为95.0%（95%CI 90.7 - 97.7），准确性为71.7%（95%CI 67.4 - 74.6）。2015年AGA指南将使接受手术切除的患者减少60%，并在95%的无症状PCN患者中准确推荐监测。未来需要进行前瞻性研究来验证这些指南。会议报告：部分内容在2016年消化系统疾病周上发表。
