Abstract：
UNASSIGNED: The guidelines regarding the management of intraductal papillary mucinous neoplasms (IPMNs) all have slightly different surgical indications for high-risk lesions. We aim to retrospectively compare the accuracy of four guidelines in recommending surgery for high-risk IPMNs, and assess the accuracy of elevated CA-19-9 levels and imaging characteristics of IPMNs considered high-risk in predicting malignancy or high-grade dysplasia (HGD).
UNASSIGNED: The final histopathological diagnosis of surgically resected high-risk IPMNs during 2013-2020 were compared to preoperative surgical indications, as enumerated in four guidelines: the 2015 American Gastroenterological Association (AGA), 2017 International Consensus, 2018 European Study Group, and 2018 American College of Gastroenterology (ACG). Surgery was considered \"justified\" if histopathology of the surgical specimen showed HGD/malignancy, or there was postoperative symptomatic improvement.
UNASSIGNED: Surgery was postoperatively justified in 26/65 (40.0%) cases. All IPMNs with HGD/malignancy were detected by the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines. The combined (\"high-risk stigmata\" and \"worrisome features\") 2017 International guideline missed 1/19 (5.3%) IPMNs with HGD/malignancy. The 2015 AGA guideline missed the most cases (11/19, 57.9%) of IPMNs with HGD/malignancy. We found the features most-associated with HGD/malignancy were pancreatic ductal dilation, and elevated CA-19-9 levels.
UNASSIGNED: Following the 2015 AGA guideline results in the highest rate of missed HGD/malignancy, but the lowest rate of operating on IPMNs without these features; meanwhile, the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines result in more operations for IPMNs without HGD/malignancy, but the lowest rates of missed HGD/malignancy in IPMNs.
UNASSIGNED: The final histopathological diagnosis of surgically resected high-risk IPMNs during 2013-2020 were compared to preoperative surgical indications, as enumerated in four guidelines: the 2015 American Gastroenterological Association (AGA), 2017 International Consensus, 2018 European Study Group, and 2018 American College of Gastroenterology (ACG). Surgery was considered \"justified\" if histopathology of the surgical specimen showed HGD/malignancy, or there was postoperative symptomatic improvement.
UNASSIGNED: Surgery was postoperatively justified in 26/65 (40.0%) cases. All IPMNs with HGD/malignancy were detected by the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines. The combined (\"high-risk stigmata\" and \"worrisome features\") 2017 International guideline missed 1/19 (5.3%) IPMNs with HGD/malignancy. The 2015 AGA guideline missed the most cases (11/19, 57.9%) of IPMNs with HGD/malignancy. We found the features most-associated with HGD/malignancy were pancreatic ductal dilation, and elevated CA-19-9 levels.
UNASSIGNED: Following the 2015 AGA guideline results in the highest rate of missed HGD/malignancy, but the lowest rate of operating on IPMNs without these features; meanwhile, the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines result in more operations for IPMNs without HGD/malignancy, but the lowest rates of missed HGD/malignancy in IPMNs.
摘要：
■关于导管内乳头状粘液性肿瘤（IPMNs）的治疗指南对高危病变的手术指征都略有不同。我们的目的是回顾性比较四个指南在推荐高危IPMN手术的准确性。并评估CA-19-9水平升高的准确性和被认为是高风险的IPMNs的影像学特征在预测恶性肿瘤或高级别异型增生（HGD）方面的准确性。
■将2013-2020年期间手术切除的高风险IPMNs的最终组织病理学诊断与术前手术适应症进行比较，正如四项指南所列举的：2015年美国胃肠病学协会(AGA)，2017年国际共识2018欧洲研究小组，和2018年美国胃肠病学学院（ACG）。如果手术标本的组织病理学显示HGD/恶性肿瘤，则认为手术是“合理的”。或术后症状改善。
■26/65例（40.0%）患者术后合理手术。所有患有HGD/恶性肿瘤的IPMN均由2018年ACG和2018年欧洲指南联合（绝对和相对标准）检测。综合（“高风险污名”和“令人担忧的特征”）2017年国际指南错过了1/19（5.3％）患有HGD/恶性肿瘤的IPMNs。2015年AGA指南错过了大多数HGD/恶性肿瘤IPMNs（11/19，57.9％）。我们发现与HGD/恶性肿瘤最相关的特征是胰腺导管扩张，和升高的CA-19-9水平。
■遵循2015年AGA指南，HGD/恶性肿瘤的漏诊率最高，但在没有这些功能的IPMN上运行的速率最低；同时，2018年ACG和2018年欧洲综合指南（绝对和相对标准）导致IPMNs更多无HGD/恶性肿瘤的手术，但IPMNs中HGD/恶性肿瘤的漏诊率最低。
■将2013-2020年期间手术切除的高风险IPMNs的最终组织病理学诊断与术前手术适应症进行比较，正如四项指南所列举的：2015年美国胃肠病学协会(AGA)，2017年国际共识2018欧洲研究小组，和2018年美国胃肠病学学院（ACG）。如果手术标本的组织病理学显示HGD/恶性肿瘤，则认为手术是“合理的”。或术后症状改善。
■26/65例（40.0%）患者术后合理手术。所有患有HGD/恶性肿瘤的IPMN均由2018年ACG和2018年欧洲指南联合（绝对和相对标准）检测。综合（“高风险污名”和“令人担忧的特征”）2017年国际指南错过了1/19（5.3％）患有HGD/恶性肿瘤的IPMNs。2015年AGA指南错过了大多数HGD/恶性肿瘤IPMNs（11/19，57.9％）。我们发现与HGD/恶性肿瘤最相关的特征是胰腺导管扩张，和升高的CA-19-9水平。
■遵循2015年AGA指南，HGD/恶性肿瘤的漏诊率最高，但在没有这些功能的IPMN上运行的速率最低；同时，2018年ACG和2018年欧洲综合指南（绝对和相对标准）导致IPMNs更多无HGD/恶性肿瘤的手术，但IPMNs中HGD/恶性肿瘤的漏诊率最低。
