Efficacy evaluation of the indications for surgery in different guidelines for predicting malignancy of mucinous pancreatic cystic neoplasms

Objective To evaluate the performance of the Sendai Guidelines, Fukuoka Guidelines and Pancreatic Cystic Lesions Management Guidelines(Chinese guidelines) in predicting malignant mucinous pancreatic cystic neoplasms (PCN). Methods A retrospective analysis of 196 patients, who received surgery and were pathologically identified as PCN or intraductal papillary mucinous neoplasms (IPMN), underwent surgical resection in Ruijin Hospital affiliated with Shanghai Jiao Tong University from January 2003 to April 2017 was performed. The differences on clinical and pathological parameters between malignant mucinous and benign mucinous PCN were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the indications for surgery in the Sendai, Fukuoka and Chinese Guidelines in predicting malignant mucinous PCN were calculated. Results Of 196 patients, 39 patients (19.9%) were confirmed as malignant tumors and 157 patients (80.1%) were confirmed as benign tumors by pathology. There were significant differences on age, symptoms (abdominal pain, jaundice or pancreatitis), tumor solid composition, pancreatic duct diameter, tumor site, tumor diameter>3 cm, and serum CA199 level between malignant and benign patients (all P<0.05). But there were no significant differences on gender distribution, tumor diameter, mural nodules and the proportion of mucinous cystic neoplasm (MCN) and intra-ductal papillary mucinous neoplasm (IPMN). 165 patients (84.2%) met the Sendai Guidelines, 153 patients (78.1%) met the Chinese guideline, and only 61 patients (31.1%) met the Fukuoka Guidelines. All 39 patients with malignant tumors met the indications in Sendai Guidelines and Chinese guidelines, and only 35 patients had the indication for surgery in the Fukuoka Guidelines. The accuracy, sensitivity, specificity, PPV and NPV of the Fukuoka Guidelines for predicting the malignancy were 84.7%, 89.7%, 83.4%, 57.4% and 97.0%, compared to 35.7%, 100%, 19.8%, 23.6% and 100% for the Sendai and 41.8%, 100%, 27.4%, 25.5% and 100% for the Chinese guidelines, respectively. Conclusions The performance of the Chinese guideline is slightly better than the Sendai Guidelines, while both of them can lead to a larger number of patients undergoing unnecessary surgical resection. Though the rate of missed diagnosis could reach 10.3%, the Fukuoka Guidelines gets the highest accuracy. Key words: Pancreatic neoplasms; Neoplasms, cystic, mucinous and serous; Surgical procedures, operative; Guidebooks; Forecasting