Department of gastroenterology and hepatology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of hepatobiliary and pancreatic surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Acta Gastroenterol Belg. 2021 Jul-Sep;84(3):443-450. doi: 10.51821/84.3.006.
The international consensus Fukuoka guideline (Fukuoka ICG), The European evidence-based guideline on pancreatic cystic neoplasms (European EBG) and the American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts (AGA IG) are 3 frequently cited guidelines for the risk stratification of neoplastic pancreatic cysts. The aim of this study was to assess the accuracy of detecting malignant cysts by strictly applying these guidelines retrospectively to a cohort of surgically resected pancreatic cysts.
72 resected cysts were included in the analysis. Invasive carcinoma, high grade dysplasia and neuro-endocrine tumour were considered as "malignant cysts" for the purpose of the study.
32% of the resected cysts were malignant. The analysis showed that the Fukuoka ICG, European EBG and AGA IG had a sensitivity of 66,8%, 95,5%, 80%; a specificity of 26,8%, 11,3%, 43,8%; a positive predictive value of 31,8%, 35%, 47,1% and a negative predicted value of 61,1%, 83,3%, 77,8% respectively. The missed malignancy rate was respectively 11,3%, 1,5%, 7,7% and surgical overtreatment was respectively 48,4%, 59,1%, 34,6%.
In this retrospective analysis, the European EBG had the lowest rate of missed malignancy at the expense of a high number of "unnecessary" resections. The Fukuoka ICG had the highest number of missed malignancy. The AGA IG showed the lowest rate of unnecessary surgery at the cost of a high number of missed malignancy. There is need to develop better biomarkers to predict the risk of malignancy.
国际福冈指南（福冈 ICG）、欧洲胰腺囊性肿瘤循证指南（欧洲 EBG）和美国胃肠病学会胰腺无症状肿瘤性囊肿诊治指南（AGA IG）是 3 项常用于胰腺肿瘤性囊肿危险分层的指南。本研究旨在严格按照这些指南回顾性评估其对手术切除的胰腺囊肿队列中恶性囊肿的检出准确性。
纳入 72 例切除的囊肿进行分析。侵袭性癌、高级别异型增生和神经内分泌肿瘤被视为研究目的的“恶性囊肿”。
32%的切除囊肿为恶性。分析表明，福冈 ICG、欧洲 EBG 和 AGA IG 的灵敏度分别为 66.8%、95.5%和 80%；特异性分别为 26.8%、11.3%和 43.8%；阳性预测值分别为 31.8%、35%和 47.1%；阴性预测值分别为 61.1%、83.3%和 77.8%。漏诊恶性的比例分别为 11.3%、1.5%和 7.7%，过度手术的比例分别为 48.4%、59.1%和 34.6%。
在这项回顾性分析中，欧洲 EBG 以较高的“不必要”切除率为代价，漏诊恶性的比例最低。福冈 ICG 漏诊恶性的比例最高。AGA IG 以较高的漏诊恶性率为代价，不必要手术的比例最低。需要开发更好的生物标志物来预测恶性风险。
