International guidelines for the management of intraductal papillary mucinous neoplasms of the pancreas recommend surgical resection of those with specific characteristics.
Dr Neeraj Anand and colleagues from California, USA performed a meta-analysis to evaluate the risk of malignancy associated with each of these features of intraductal papillary mucinous neoplasms.
The researchers performed a comprehensive search of MEDLINE from 1996, to 2011, for studies that included any of the features mentioned in the consensus guidelines for surgical resection of main duct and branch duct intraductal papillary mucinous neoplasms.
The team analyzed data from 41 studies for cyst size greater than 3 cm, the presence of mural nodules, dilated main pancreatic duct, symptoms, and main duct vs branch duct intraductal papillary mucinous neoplasms.
Malignant intraductal papillary mucinous neoplasms were defined as those with carcinoma in situ or more advanced histology.
|Cyst size greater than 3 cm was associated most strongly with malignancy|
|Clinical Gastroenterology and Hepatology|
A separate meta-analysis was performed for each risk factor to calculate pooled odds ratios.
A random-effects model was used, based on the assumption of variation among study populations.
The doctors found that the risks of malignancy associated with individual cyst features included cyst size greater than 3 cm, presence of a mural nodule, dilatation of the main pancreatic duct, and main vs branch duct intraductal papillary mucinous neoplasms.
There was a moderate level of heterogeneity among studies.
Dr Anand's team concluded, "Based on a meta-analysis, cyst features proposed by the international guidelines for resection of intraductal papillary mucinous neoplasms were highly associated with malignancy. "
"However, based on our findings, not all cyst features should be weighted equally when considering risk of malignancy."
"Cyst size greater than 3 cm was associated most strongly with malignant intraductal papillary mucinous neoplasms."