Evaluation of efficacy of pancreatic juice cytology for risk classification according to international consensus guidelines in patients with intraductal papillary mucinous neoplasm; a retrospective study
Evaluation of efficacy of pancreatic juice cytology for risk classification according to international consensus guidelines in patients with intraductal papillary mucinous neoplasm; a retrospective study
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DOI：
10.1016/j.pan.2019.02.013
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发表时间：
2019-04-01
期刊：
影响因子：
3.6
通讯作者：
Kodama, Yuzo
中科院分区：
文献类型：
--
作者：
Yamakawa, Kohei;Masuda, Atsuhiro;Kodama, Yuzo
目的：胰腺导管内乳头状黏液性肿瘤（IPMN）的胰液细胞学（PJC）是一种可能的工具，以提高术前诊断能力，通过改善恶性IPMN的风险分类，但其有效性是有争议的。本研究评价了根据国际指南PJC风险分级的有效性。方法：我们回顾性分析了127例IPMN患者术前行内镜逆行胰胆管造影（ERCP）。在127例病例中，125例进行了PJC。根据2017年国际指南对高危标志（HRS，n = 57）、令人担忧的特征（WF，n = 64）和其他特征（n = 6）进行分类。结果：在127例IPMN患者中，71例（55.9%）患有恶性IPMN（侵袭性和非侵袭性导管内乳头状粘液癌）。加入PJC后，WF对恶性IPMN分类的准确性增加，但HRS的准确性没有增加（WF对WF刺PJC：33.1%[42/127]至48.8%[61/125]，HRS对HRS刺PJC：65.4%[83/127]至52.8%[66/125]）。127例IPMN患者中，32例（25.2%）发生ERCP后胰腺炎（PEP）。未检测到重度PEP。PEP的显著危险因素是女性、肥胖和内镜下鼻胰引流（ENPD）（分别为P =.03、P =.0006和P =.02）。在ENPD管放置的患者中，主胰管尺寸为
Objectives: Pancreatic juice cytology (PJC) for intraductal papillary mucinous neoplasm (IPMN) is a possible tool to enhance preoperative diagnostic ability by improving risk classification for malignant IPMN, but its efficacy is controversial. This study evaluated the efficacy of PJC for risk classification according to international guidelines.Methods: We retrospectively analyzed 127 IPMN patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) preoperatively. PJC was performed in 125 of the 127 cases. High-risk stigmata (HRS, n = 57), worrisome features (WF, n = 64), and other characteristics (n = 6) were classified according to the 2017 international guidelines.Results: Among the 127 IPMN patients, 71 (55.9%) had malignant IPMN (invasive and non-invasive intraductal papillary mucinous carcinoma). The accuracy of WF for classifying malignant IPMN was increased by the addition of PJC, but the accuracy of HRS was not (WF to WF thorn PJC: 33.1% [42/127] to 48.8% [61/125], HRS to HRS thorn PJC: 65.4% [83/127] to 52.8% [66/125]). Post-ERCP pancreatitis (PEP) occurred in 32 (25.2%) of 127 IPMN patients. Severe PEP was not detected. Significant risk factors for PEP were female sex, obesity, and endoscopic naso-pancreatic drainage (ENPD) (P = .03, P = .0006, and P = .02, respectively). In patients with ENPD tube placement, a main pancreatic duct size of