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Mahmud O, Fatimi AS, Grewal M, DiMaggio C, Hewitt DB, Javed AA, Wolfgang CL, Sacks GD. Risk of pancreatic cancer and high-grade dysplasia in resected main-duct and mixed-type intraductal papillary mucinous neoplasms: A prevalence meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109742. [PMID: 40117982 DOI: 10.1016/j.ejso.2025.109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/13/2025] [Accepted: 03/03/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Current guidelines recommend the resection of main duct- (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMN) based on specific risk criteria to prevent or treat pancreatic cancer in selected patients. This paradigm follows high rates of malignancy observed in published surgical series. The aim of this systematic review and meta-analysis was to provide robust, pooled rates of invasive carcinoma (IC) and high-grade dysplasia (HGD) in resected MD- and MT-IPMNs of the pancreas. METHODS The PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL databases were systematically searched. Studies that reported rates of IC or HGD, diagnosed by histopathology of surgical specimens, in MD- or MT-IPMNs were included. Pooled prevalence with 95 % confidence interval (95 % CI) was calculated using a random effects model. Galbraith plots were used to evaluate heterogeneity. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool. RESULTS Based on 51 studies, 59 % (95 % CI: 54 %, 64 %) of resected MD- and MT-IPMN had IC or HGD, with IC in up to 39 % (95 % CI: 33 %, 44 %) of lesions and HGD in 20 % (95 % CI: 16 %, 25 %). Most studies were deemed to be of good quality and Galbraith plots demonstrated high concordance. CONCLUSIONS These results confirm the rates of IC and HGD in resected MD/MT-IPMNs. However, a significant proportion of patients have benign lesions, and future research is needed to develop precise diagnostics to distinguish between patients with and without high-risk or cancerous disease.
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Affiliation(s)
- Omar Mahmud
- Medical College, Aga Khan University, Karachi, Pakistan; NYU Langone Health, NYU Grossman School of Medicine, New York City, USA
| | - Asad Saulat Fatimi
- Medical College, Aga Khan University, Karachi, Pakistan; NYU Langone Health, NYU Grossman School of Medicine, New York City, USA
| | - Mahip Grewal
- NYU Langone Health, NYU Grossman School of Medicine, New York City, USA
| | - Charles DiMaggio
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - D Brock Hewitt
- NYU Langone Health, NYU Grossman School of Medicine, New York City, USA
| | - Ammar A Javed
- NYU Langone Health, NYU Grossman School of Medicine, New York City, USA
| | | | - Greg D Sacks
- NYU Langone Health, NYU Grossman School of Medicine, New York City, USA.
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Wood LD, Adsay NV, Basturk O, Brosens LAA, Fukushima N, Hong SM, Kim SJ, Lee JW, Luchini C, Noë M, Pitman MB, Scarpa A, Singhi AD, Tanaka M, Furukawa T. Systematic review of challenging issues in pathology of intraductal papillary mucinous neoplasms. Pancreatology 2023; 23:878-891. [PMID: 37604731 DOI: 10.1016/j.pan.2023.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) are a cystic precursor to pancreatic cancer. IPMNs deemed clinically to be at high-risk for malignant progression are frequently treated with surgical resection, and pathological examination of the pancreatectomy specimen is a key component of the clinical care of IPMN patients. METHODS Systematic literature reviews were conducted around eight topics of clinical relevance in the examination of pathological specimens in patients undergoing resection of IPMN. RESULTS This review provides updated perspectives on morphological subtyping of IPMNs, classification of intraductal oncocytic papillary neoplasms, nomenclature for high-grade dysplasia, assessment of T stage, distinction of carcinoma associated or concomitant with IPMN, role of molecular assessment of IPMN tissue, role of intraoperative assessment by frozen section, and preoperative evaluation of cyst fluid cytology. CONCLUSIONS This analysis provides the foundation for data-driven approaches to several challenging issues in the pathology of IPMNs.
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Affiliation(s)
- Laura D Wood
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - N Volkan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Olca Basturk
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Noriyoshi Fukushima
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Joo Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae W Lee
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, 37134, Verona, Italy; ARC-Net Research Center, University of Verona, 37134, Verona, Italy
| | - Michaël Noë
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, 37134, Verona, Italy; ARC-Net Research Center, University of Verona, 37134, Verona, Italy
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mariko Tanaka
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Lin J. Comment on: Malignant potential and specific characteristics of pure main duct type intraductal papillary mucinous neoplasm. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:300. [PMID: 35987799 DOI: 10.1016/j.ejso.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Jianzhen Lin
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Pancreas Institute, Nanjing Medical University, Nanjing, 210000, China.
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