General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Radiology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Surgery. 2018 Jun;163(6):1272-1279. doi: 10.1016/j.surg.2018.01.009. Epub 2018 Feb 14.
Mural nodules (MNs) have a predominant role in the 2016 revision of the international guidelines on intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The aim of this study was to evaluate MNs as predictors of invasive cancer (iCa) or high-grade dysplasia (HGD) in IPMNs and to investigate the role of MN size in risk prediction.
A PRISMA-compliant systematic review of the literature and meta-analysis on selected studies were conducted. The random effect model was adopted, and the pooled SMD (standardized mean difference) obtained. The surgical series of IPMNs at a single high-volume institution was reviewed.
This review included 70 studies and 2297 resected IPMNs. MNs have a positive predictive value for malignancy of 62.2%. The meta-analysis suggested that MN size has a considerable effect on predicting IPMNs with both iCa or HGD with a mean SMD of 0.79. All studies included in the meta-analysis used contrast-enhanced endosonography (CE-EUS) to assess MNs. Due to the heterogeneity of the proposed thresholds, no reliable MN size cut-off was identified. Of 317 IPMNs resected at our institution, 102 (32.1%) had a preoperative diagnosis of MN. Multivariate analysis showed that MN is the only independent predictor of iCa and HGD for all types of IPMNs.
MNs are reliable predictors of iCa and HGD in IPMNs as proposed by the 2016 IAP guidelines. CE-EUS seems to be the best tool for characterizing size and has the best accuracy for predicting malignancy. Further studies should determine potential MN dimensional cut-offs.
壁结节（MNs）在 2016 年国际胰腺导管内乳头状黏液性肿瘤（IPMN）指南修订版中具有主要作用。本研究旨在评估 MNs 是否为 IPMNs 浸润性癌（iCa）或高级别异型增生（HGD）的预测因子，并研究 MN 大小在风险预测中的作用。
对选定研究进行了 PRISMA 符合的文献系统评价和荟萃分析。采用随机效应模型，并获得汇总的 SMD（标准化均数差）。对单一高容量机构的 IPMNs 手术系列进行了回顾。
本综述包括 70 项研究和 2297 例切除的 IPMNs。MNs 对恶性肿瘤的阳性预测值为 62.2%。荟萃分析表明，MN 大小对预测具有 iCa 或 HGD 的 IPMNs 具有相当大的影响，平均 SMD 为 0.79。荟萃分析中包含的所有研究均使用对比增强内镜超声（CE-EUS）评估 MNs。由于提出的阈值存在异质性，因此无法确定可靠的 MN 大小截止值。在我们机构切除的 317 例 IPMNs 中，102 例（32.1%）术前诊断为 MN。多变量分析表明，MN 是所有类型 IPMNs 发生 iCa 和 HGD 的唯一独立预测因子。
MNs 是 2016 年 IAP 指南中提出的 IPMNs 发生 iCa 和 HGD 的可靠预测因子。CE-EUS 似乎是评估大小的最佳工具，并且对预测恶性肿瘤的准确性最高。需要进一步的研究来确定潜在的 MN 维度截止值。
