OBJECTIVE To evaluate the diagnostic performance of surgical indications of the revised International Association of Pancreatology (IAP) 2023 guidelines compared to the IAP 2017 and European 2018 guidelines. SUMMARY BACKGROUND DATA The revised IAP guidelines for surgical indications for branch duct (BD) intraductal papillary mucinous neoplasms (IPMN) include the presence of at least two worrisome features without mandatory endoscopic ultrasound. METHODS Among 663 patients who underwent resection for pathologically confirmed IPMN in a tertiary hospital between 2013 and 2023, 556 patients with BD or mixed-type IPMN were retrospectively reviewed. Diagnostic performances of the three guidelines for predicting high-grade dysplasia or IPMN with invasive carcinoma were compared. The primary outcome was the malignancy rate. Clinicopathological and radiological imaging data were analyzed. RESULTS A total of 540, 451, and 490 patients met the surgical indications of the IAP, 2017, 2023, and European guidelines, respectively. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia, n=99; invasive carcinoma, n=130). Surgical indication by the IAP 2023 guidelines showed higher specificity (29.1 vs. 4.9%, P<0.001), positive predictive value (48.6 vs. 42.4%, P=0.031), and accuracy (55.5 vs. 44.1%, P<0.001) than the IAP 2017 guidelines. It also had higher specificity than the European guidelines (18.7%, P=0.024). The IAP 2023 guidelines showed a superior AUC of surgical indication (0.623 vs. 0.582 for the European guidelines, P<0.001; and 0.524 for the IAP guidelines, P=0.008). CONCLUSIONS The IAP 2023 guidelines showed better malignancy prediction than the IAP 2017 and European guidelines, potentially reducing unnecessary surgeries.

中文翻译：

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国际胰腺学会 (IAP) 2023 年修订版指南中分支导管或混合型导管内乳头状粘液性肿瘤手术指征的诊断性能。


目的 与 IAP 2017 和欧洲 2018 指南相比，评估修订后的国际胰腺学会 (IAP) 2023 指南的手术指征诊断性能。摘要背景数据修订后的 IAP 指南关于分支导管 (BD) 导管内乳头状粘液性肿瘤 (IPMN) 的手术指征包括在没有强制内镜超声检查的情况下存在至少两个令人担忧的特征。方法回顾性分析2013年至2023年某三甲医院因病理证实IPMN而接受手术切除的663例患者中556例BD型或混合型IPMN患者的资料。比较了三个指南预测高度不典型增生或伴有浸润性癌的 IPMN 的诊断性能。主要结果是恶性肿瘤率。分析临床病理学和放射学成像数据。结果 共有 540 例、451 例和 490 例患者分别符合 IAP、2017 年、2023 年和欧洲指南的手术指征。在 229 名 (41.2%) 患者中观察到恶性 IPMN（高度不典型增生，n=99；浸润性癌，n=130）。 IAP 2023 指南的手术指征显示出更高的特异性（29.1 vs. 4.9%，P<0.001）、阳性预测值（48.6 vs. 42.4%，P=0.031）和准确性（55.5 vs. 44.1%，P%） 3C0.001）高于 IAP 2017 指南。它还具有比欧洲指南更高的特异性（18.7%，P=0.024）。 IAP 2023 指南显示手术适应症的 AUC 更高（欧洲指南为 0.623 vs. 0.582，P<0.001；IAP 指南为 0.524，P=0.008）。结论 IAP 2023 指南显示出比 IAP 2017 和欧洲指南更好的恶性肿瘤预测，可能减少不必要的手术。