Misunderstandings of Pancreatic Cystic Neoplasms and How to Avoid Them——Interpretation of 2018 European Evidence-based Guidelines on Pancreatic Cystic Neoplasms

doi:10.12114/j.issn.1007-9572.2019.00.721

Abstract

Abstract: Pancreatic cystic neoplasm（PCN） is a kind of disease with large differences in pathological characteristics，which is divided into benign，malignant and conjunctive malignant neoplasm.Various domestic and international guidelines on how to carry out normative management of PCN have been put forward with corresponding expert consensus with updating and improving constantly.In this paper，the main points of the 2018 European Evidence-based Guidelines on Pancreatic Cystic Neoplasms are interpreted.These guidelines are strategies for diagnosis and treatment and follow-up of PCN firstly based on evidence.This article summarizes and analyzes the core principles of these guidelines in order to provide a reference for improving the diagnosis and management of PCN in China.

Key words: Pancreatic cystic neoplasms, Management, Guideline, Evidence-based medicine

摘要： 胰腺囊性肿瘤（PCN）是病理特征差异较大的一类疾病，分为良性、恶性及交界恶性，国内外各项指南就如何规范管理提出了相应的专家共识并不断更新完善。本文对2018版《欧洲胰腺囊性肿瘤循证指南》要点进行了解读，该指南是第一部以循证依据为基础制定的胰腺囊性肿瘤诊治、随访的策略，本文将对其核心内容进行总结及分析，旨在提供借鉴，改善我国PCN的诊断和管理。

关键词: 胰腺囊性肿瘤, 管理, 指南, 循证医学

ZHANG Lixian1,ZHAO Dongqiang. Misunderstandings of Pancreatic Cystic Neoplasms and How to Avoid Them——Interpretation of 2018 European Evidence-based Guidelines on Pancreatic Cystic Neoplasms　[J]. Chinese General Practice, 2019, 22(35): 4283-4287. DOI: 10.12114/j.issn.1007-9572.2019.00.721.
张丽贤,赵东强. 胰腺囊性肿瘤认知误区及应对策略——2018版《欧洲胰腺囊性肿瘤循证指南》解读[J]. 中国全科医学, 2019, 22(35): 4283-4287. DOI: 10.12114/j.issn.1007-9572.2019.00.721.

References

［1］ZANINI N，GIORDANO M，SMERIERI E，et al．Estimation of the prevalence of asymptomatic pancreatic cysts in the population of San Marino［J］．Et Al，2015，15（4）：417-422．DOI：10.1016/j.pan.2015.05.461.
［2］European Study Group on Cystic Tumours of the Pancreas.European evidence-based guidelines on pancreatic cystic neoplasms［J］．Gut，2018，67（5）：789-804．DOI：10.1136/gutjnl-2018-316027.
［3］DEL CHIARO M，SEGERSV?RD R，POZZI MUCELLI R，et al．Comparison of preoperative conference-based diagnosis with histology of cystic tumors of the pancreas［J］．Ann Surg Oncol，2014，21（5）：1539-1544．DOI：10.1245/s10434-013-3465-9.
［4］JANG D K，SONG B J，RYU J K，et al．Preoperative diagnosis of pancreatic cystic lesions：the accuracy of endoscopic ultrasound and cross-sectional imaging［J］．Pancreas，2015，44（8）：1329-1333．DOI：10.1097/MPA.0000000000000396.
［5］GARDNER T B，GLASS L M，SMITH K D，et al．Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults［J］．Am J Gastroenterol，2013，108（10）：1546-1550．DOI：10.1038/ajg.2013.103.
［6］FARRELL J J，FERNáNDEZ-DEL CASTILLO C.Pancreatic cystic neoplasms：management and unanswered questions［J］．Gastroenterology，2013，144（6）：1303-1315．DOI：10.1053/j.gastro.2013.01.073.
［7］WINNER M，SETHI A，PONEROS J M，et al．The role of molecular analysis in the diagnosis and surveillance of pancreatic cystic neoplasms［J］．JOP，2015，16（2）：143-149．DOI：10.6092/1590-8577/2941.
［8］KADAYIFCI A，AL-HADDAD M，ATAR M，et al．The value of KRAS mutation testing with CEA for the diagnosis of pancreatic mucinous cysts［J］．Endosc Int Open，2016，4（4）：E391-396．DOI：10.1055/s-0042-101755.
［9］NGAMRUENGPHONG S，BARTEL M J，RAIMONDO M.Cyst carcinoembryonic antigen in differentiating pancreatic cysts：a meta-analysis［J］．Dig Liver Dis，2013，45（11）：920-926．DOI：10.1016/j.dld.2013.05.002.
［10］中华医学会外科学分会胰腺外科学组.胰腺囊性疾病诊治指南（2015）［J］．中华外科杂志，2015，53（9）：641-645．DOI：10.3760/cma.j.issn.0529-5815.2015.09.001.http：//www.cnki.com.cn/Article/CJFDTotal-ZGWK201509014.htm.
［11］DEL CHIARO M，ATEEB Z，HANSSON M R，et al．Survival analysis and risk for progression of intraductal papillary mucinous neoplasia of the pancreas （IPMN） under surveillance：a single-institution experience［J］．Ann Surg Oncol，2017，24（4）：1120-1126．DOI：10.1245/s10434-016-5661-x.
［12］SHIRAKAWA S，MATSUMOTO I，TOYAMA H，et al．Pancreatic volumetric assessment as a predictor of new-onset diabetes following distal pancreatectomy［J］．J Gastrointest Surg，2012，16（12）：2212-2219．DOI：10.1007/s11605-012-2039-7.
［13］GOUDARD Y，GAUJOUX S，DOKMAK S，et al．Reappraisal of central pancreatectomy a 12-year single-center experience［J］．JAMA Surg，2014，149（4）：356-363．DOI：10.1001/jamasurg.2013.4146.
［14］REID M D，CHOI H J，MEMIS B，et al．Serous neoplasms of the pancreas：a clinicopathologic analysis of 193 cases and literature review with new insights on macrocystic and solid variants and critical reappraisal of so-called “serous cystadenocarcinoma”［J］．Am J Surg Pathol，2015，39（12）：1597-1610．DOI：10.1097/PAS.0000000000000559.
［15］JAIS B，REBOURS V，MALLEO G，et al．Serous cystic neoplasm of the pancreas：a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club （European Study Group on Cystic Tumors of the Pancreas）［J］．Gut，2016，65（2）：305-312．DOI：10.1136/gutjnl-2015-309638.
［16］CRIPPA S，PEZZILLI R，BISSOLATI M，et al．Active surveillance beyond 5 years is required for presumed branch-duct intraductal papillary mucinous neoplasms undergoing non-operative management［J］．Am J Gastroenterol，2017，112（7）：1153-1161．DOI：10.1038/ajg.2017.43.
［17］LAWRENCE S A，ATTIYEH M A，SEIER K，et al．Should patients with cystic lesions of the pancreas undergo long-term radiographic surveillance？：Results of 3024 patients evaluated at a single institution［J］．Ann Surg，2017，266（3）：536-544．DOI：10.1097/SLA.0000000000002371.
［18］NILSSON L N，KEANE M G，SHAMALI A，et al．Nature and management of pancreatic mucinous cystic neoplasm （MCN）：a systematic review of the literature［J］．Et Al，2016，16（6）：1028-1036．DOI：10.1016/j.pan.2016.09.011.
［19］SAHORA K，FERRONE C R，BRUGGE W R，et al．Effects of comorbidities on outcomes of patients with intraductal papillary mucinous neoplasms［J］．Clin Gastroenterol Hepatol，2015，13（10）：1816-1823．DOI：10.1016/j.cgh.2015.04.177.
［20］BERLAND L L，SILVERMAN S G，GORE R M，et al．Managing incidental findings on abdominal CT：white paper of the ACR incidental findings committee［J］．J Am Coll Radiol，2010，7（10）：754-773．DOI：10.1016/j.jacr.2010.06.013.
［21］SODICKSON A，BAEYENS P F，ANDRIOLE K P，et al．Recurrent CT，cumulative radiation exposure，and associated radiation-induced cancer risks from CT of adults［J］．Radiology，2009，251（1）：175-184．DOI：10.1148/radiol.2511081296.
［22］SAHANI D V，KAMBADAKONE A，MACARI M，et al．Diagnosis and management of cystic pancreatic lesions［J］．AJR Am J Roentgenol，2013，200（2）：343-354．DOI：10.2214/AJR.12.8862.
［23］GOH B K.International guidelines for the management of pancreatic intraductal papillary mucinous neoplasms［J］．World J Gastroenterol，2015，21（34）：9833-9837．DOI：10.3748/wjg.v21.i34.9833.
［24］SAHORA K，MINO-KENUDSON M，BRUGGE W，et al．Branch duct intraductal papillary mucinous neoplasms：does cyst size change the tip of the scale？A critical analysis of the revised international consensus guidelines in a large single-institutional series［J］．Ann Surg，2013，258（3）：466-475．DOI：10.1097/SLA.0b013e3182a18f48.
［25］DEL CHIARO M，ATEEB Z，HANSSON M R，et al．Survival analysis and risk for progression of intraductal papillary mucinous neoplasia of the pancreas （IPMN） under surveillance：a single-institution experience［J］．Ann Surg Oncol，2017，24（4）：1120-1126．DOI：10.1245/s10434-016-5661-x.
［26］DAS A，WELLS C D，NGUYEN C C.Incidental cystic neoplasms of pancreas：what is the optimal interval of imaging surveillance？［J］．Am J Gastroenterol，2008，103（7）：1657-1662．DOI：10.1111/j.1572-0241.2008.01893.x.

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