Медицинская литература. Новинки

 

 

 

 

 

 

Результаты Международного консенсуса по диагностике и лечению пациентов с серозными и муцинозными кистозными неоплазиями поджелудочной железы

Вы можете загрузить полный текст статьи в формате pdf

В 2023 г. по согласованию с руководством Ассоциации гепатопанкреатобилиарных хирургов стран СНГ было инициировано и проведено согласительное исследование по диагностике, лечению и наблюдению пациентов с серозными и муцинозными неоплазиями поджелудочной железы. На основании литературных справок были сформулированы ответы на каждый из 22 вопросов, оформленные в виде Консенсуса. В подготовке Консенсуса приняли участие 44 эксперта, представляющие 27 учреждений в 9 странах. Голосование проводили по методу Делфи, и в конечном итоге, включая результаты голосования по ряду положений на итоговой конференции, по всем вопросам был достигнут консенсус.

Ключевые слова:
поджелудочная железа, неоплазия, кистозное новообразование, IPMN, муцинозная цистаденома, серозная цистаденома, pancreas, neoplasia, cystic tumor, IPMN, mucinous cystadenoma, serous cystadenoma

Литература:
1.Udare A., Agarwal M., Alabousi M., McInnes M., Rubino J.G., Marcaccio M., van der Pol C.B. Diagnostic accuracy of MRI for differentiation of benign and malignant pancreatic cystic lesions compared to CT and endoscopic ultrasound: systematic review and meta-analysis. J. Magn. Reson. Imaging. 2021; 54 (4): 1126–1137. https://doi.org/10.1002/jmri.27606
2.European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018; 67 (5): 789–804. https://doi.org/10.1136/gutjnl-2018-316027
3.Tanaka M., Chari S., Adsay V., Fernandez-del Castillo C., Falconi M., Shimizu M., Yamaguchi K., Yamao K., Matsuno S. International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006; 6 (1–2): 17–32. https://doi.org/10.1159/000090023
4.Li Y.J., Lee G.H., Yang M.J., Hwang J.C., Yoo B.M., Kim S.S., Lim S.G., Kim J.H. Diagnostic yield of transabdominal ultrasonography for evaluation of pancreatic cystic lesions compared with endoscopic ultrasonography. J. Clin. Med. 2021; 10 (19): 4616. https://doi.org/10.3390/jcm10194616
5.Cheung T.T., Lee Y.T., Tang R.S., She W.H., Cheng K.C., Cheung C.C., Chiu K.W.H., Chok K.S.H., Chow W.S., Lai T.W., Seto W.K., Yau T. The Hong Kong consensus recommendations on the diagnosis and management of pancreatic cystic lesions. Hepatobiliary Surg. Nutr. 2023; 12 (5): 715–735. https://doi.org/10.21037/hbsn-22-471
6.Mamone G., Barresi L., Tropea A., Di Piazza A., Miraglia R. MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis. Updates Surg. 2020; 72 (3): 617–637. https://doi.org/10.1007/s13304-020-00800-y
7.Кригер А.Г., Пантелеев В.И., Джигкаева М.М., Будзинский С.А. Муцинозная цистаденома поджелудочной железы – нетипичный вариант течения заболевания. Хирургия. Журнал им. Н.И. Пирогова. 2023; 12: 118–122.
8.Шабунин А.В., Тавобилов М.М., Карпов А.А., Паклина О.В., Сетдикова Г.Р., Иванова Н.А., Озерова Д.С. Ацинарно-клеточная цистаденома головки поджелудочной железы (клиническое наблюдение). Анналы хирургической гепатологии. 2020; 25 (2): 145–151. https://doi.org/10.16931/1995-5464.20202145-151.
9.Pollini T., Marchegiani G., Facciorusso A., Balduzzi A., Biancotto M., Bassi C., Maker A.V., Salvia R. It is not necessary to resect all mucinous cystic neoplasms of the pancreas: current guidelines do not reflect the actual risk of malignancy. HPB (Oxford). 2023; 25 (7): 747–757. https://doi.org/10.1016/j.hpb.2023.03.001
10.Marchegiani G., Balduzzi A., Pollini T., Caravati A., Biancotto M., Andrianello S., Zampese M., Bassi C., Salvia R. The use of a mobile application to disseminate guidelines on cystic neoplasms of the pancreas – a snapshot study of 1000 case-simulations. Pancreatology. 2021; 21 (8): 1472–1475. https://doi.org/10.1016/j.pan.2021.09.009
11.Sahora K., Mino-Kenudson M., Brugge W., Thayer S.P., Ferrone C.R., Sahani D., Pitman M.B., Warshaw A.L., Lillemoe K.D., Fernandez-del Castillo C.F. 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. Ann. Surg. 2013; 258 (3): 466–475. https://doi.org/10.1097/SLA.0b013e3182a18f48
12.Ohtsuka T., Fernandez-del Castillo C., Furukawa T., Hijioka S., Jang J., Lennon A.M., Miyasaka Y., Ohno E., Salvia R., Wolfgang C.L., Wood L.D. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2024; 24 (2): 255–270. https://doi.org/10.1016/j.pan.2023.12.009
13.Listone H.A., Turoff M. The Delphi method: techniques and applications. J. Marketing Res. 1975; 18 (3). https://doi.org/10.2307/3150755
14.Spinelli K.S., Fromwiller T.E., Daniel R.A., Kiely J.M., Nakeeb A., Komorowski R.A., Wilson S.D., Pitt H.A. Cystic pancreatic neoplasms: observe or operate. Ann. Surg. 2004; 239 (5): 651–657; discussion 657–659. https://doi.org/10.1097/01.sla.0000124299.57430.ce
15.Hashimoto S., Hirooka Y., Kawabe N., Nakaoka K., Yoshioka K. Role of transabdominal ultrasonography in the diagnosis of pancreatic cystic lesions. J. Med. Ultrason. (2001). 2020; 47 (3): 389–399. https://doi.org/10.1007/s10396-019-00975-x
16.Zerboni G., Signoretti M., Crippa S., Falconi M., Arcidiacono P.G., Capurso G. Systematic review and metaanalysis: prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology. 2019; 19 (1): 2–9. https://doi.org/10.1016/j.pan.2018.11.014
17.Putzer D., Jaschke W. Radiological evaluation of focal pancreatic lesions. Dig. Dis. 2015; 33 (1): 91–98. https://doi.org/10.1159/000366045
18.Okasha H.H., Awad A., El-Meligui A., Ezzat R., Aboubakr A., AbouElenin S., El-Husseiny R., Alzamzamy A. Cystic pancreatic lesions, the endless dilemma. World J. Gastroenterol. 2021; 27 (21): 2664–2680. https://doi.org/10.3748/wjg.v27.i21.2664
19.Pandey P., Pandey A., Luo Y., Aliyari Ghasabeh M., Khoshpouri P., Ameli S., O'Broin-Lennon A.M., Canto M., Hruban R.H., Goggins M.S., Wolfgang C., Kamel I.R. Follow-up of incidentally detected pancreatic cystic neoplasms: do baseline MRI and CT features predict cyst growth? Radiology. 2019; 292 (3): 647–654. https://doi.org/10.1148/radiol.2019181686
20.Laffan T.A., Horton K.M., Klein A.P., Berlanstein B., Siegelman S.S., Kawamoto S., Johnson P.T., Fishman E.K., Hruban R.H. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am. J. Roentgenol. 2008; 191 (3): 802–807. https://doi.org/10.2214/AJR.07.3340
21.Sahani D.V., Kambadakone A., Macari M., Takahashi N., Chari S., Fernandez-del Castillo C. Diagnosis and management of cystic pancreatic lesions. AJR Am. J. Roentgenol. 2013; 200 (2): 343–354. https://doi.org/10.2214/AJR.12.8862
22.Chaudhari V.V., Raman S.S., Vuong N.L., Zimmerman P., Farrell J., Reber H., Sayre J., Lu D.S. Pancreatic cystic lesions: discrimination accuracy based on clinical data and high resolution CT features. J. Comput. Assist. Tomogr. 2007; 31 (6): 860–867. https://doi.org/10.1097/RCT.0b013e318039b277
23.Karsenti D., Gincul R., Belle A., Vienne A., Weiss E., Vanbiervliet G., Gronier O. Antibiotic prophylaxis in digestive endoscopy: Guidelines from the French Society of Digestive Endoscopy. Endosc. Int. Open. 2024; 12 (10): E1171–E1182. https://doi.org/10.1055/a-2415-9414
24.de Jong K., Nio C.Y., Mearadji B., Phoa S.S., Engelbrecht M.R., Dijkgraaf M.G., Bruno M.J., Fockens P. Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas. 2012; 41 (2): 278–282. https://doi.org/10.1097/MPA.0b013e31822899b6
25.Kloth C., Haggenmuller B., Beck A., Wagner M., Kornmann M., Steinacker J.P., Steinacker-Stanescu N., Vogele D., Beer M., Juchems M.S. Diagnostic, structured classification and therapeutic approach in cystic pancreatic lesions: systematic findings with regard to the European guidelines. Diagnostics (Basel). 2023; 13 (3): 454. https://doi.org/10.3390/diagnostics13030454
26.van Huijgevoort N.C.M., Del Chiaro M., Wolfgang C.L., van Hooft J.E., Besselink M.G. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat. Rev. Gastroenterol. Hepatol. 2019; 16 (11): 676–689. https://doi.org/10.1038/s41575-019-0195-x
27.Mohamed E., Jackson R., Halloran C.M., Ghaneh P. Role of radiological imaging in the diagnosis and characterization of pancreatic cystic lesions: a systematic review. Pancreas. 2018; 47 (9): 1055–1064. https://doi.org/10.1097/MPA.0000000000001134
28.Zhang Y., Wu J., He J., Xu S. Preoperative differentiation of pancreatic cystic neoplasm subtypes on computed tomography radiomics. Quant. Imaging Med. Surg. 2023; 13 (10): 6395–6411. https://doi.org/10.21037/qims-22-1192
29.de Moura D.T.H., Ryou M., de Moura E.G.H., Ribeiro I.B., Bernardo W.M., Thompson C.C. Endoscopic ultrasoundguided fine needle aspiration and endoscopic retrograde cholangiopancreatography-based tissue sampling in suspected malignant biliary strictures: a meta-analysis of same-session procedures. Clin. Endosc. 2020; 53 (4): 417–428. https://doi.org/10.5946/ce.2019.053
30.Sobhrakhshankhah E., Sohrabi M., Norouzi H.R., Zamani F., Ajdarkosh H., Nikkhah M., Khoonsari M.R., Faraji A.H. Tissue sampling through endoscopic ultrasound-guided fine needle aspiration versus endoscopic retrograde cholangiopancreatographic brushing cytology technique in suspicious malig-nant biliary stricture. Middle East J. Dig. Dis. 2021; 13 (4): 294–301. https://doi.org/10.34172/mejdd.2021.238
31.Zhu H., Jiang F., Zhu J., Du Y., Jin Z., Li Z. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: a systematic review and meta-analysis. Dig. Endosc. 2017; 29 (6): 667–675. https://doi.org/10.1111/den.12851
32.Yang D., Trindade A.J., Yachimski P., Benias P., Nieto J., Manvar A., Ho S., Esnakula A., Gamboa A., Sethi A., Gupte A., Khara H.S., Diehl D.L., El Chafic A., Shah J., Forsmark C.E., Draganov P.V. Histologic analysis of endoscopic ultrasoundguided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin. Gastroenterol. Hepatol. 2019; 17 (8): 1587–1596. https://doi.org/10.1016/j.cgh.2018.11.027
33.Wang Q.X., Xiao J., Orange M., Zhang H., Zhu Y.Q. EUSguided FNA for diagnosis of pancreatic cystic lesions: a metaanalysis. Cell Physiol. Biochem. 2015; 36 (3): 1197–1209. https://doi.org/10.1159/000430290
34.Mohapatra S., Krishna S.G., Pannala R. Pancreatic cystic neoplasms: translating guidelines into clinical practice. Diagnostics (Basel). 2023; 13 (4): 749. https://doi.org/10.3390/diagnostics13040749
35.Коваленко Д.Д., Парфенчикова Е.В., Щадрова В.В., Носкова К.К., Рахметова Л.Ы., Орлова М.В., Гусарова О.А. Сложности диагностики солидной псевдопапиллярной неоплазии поджелудочной железы. Эффективная фармакотерапия. 2024; 20 (46): 88–93. https://doi.org/10.33978/2307-3586-2024-20-46-88-93.
36.Thornton G.D., McPhail M.J., Nayagam S., Hewitt M.J., Vlavianos P., Monahan K.J. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology. 2013; 13 (1): 48–57. https://doi.org/10.1016/j.pan.2012.11.313
37.Layfield L.J., Ehya H., Filie A.C., Hruban R.H., Jhala N., Joseph L., Vielh P., Pitman M.B. Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions: the Papanicolaou Society of Cytopathology guidelines. Cytojournal. 2014; 11 (Suppl. 1): 4. https://doi.org/10.4103/1742-6413.133352
38.Khan I., Baig M., Bandepalle T., Puli S.R. Utility of cyst fluid carcinoembryonic antigen in differentiating mucinous and non-mucinous pancreatic cysts: an updated meta-analysis. Dig. Dis. Sci. 2022; 67 (9): 4541–4548. https://doi.org/10.1007/s10620-021-07315-5
39.Kazmi S.Z., Jung H.S., Han Y., Yun W.G., Cho Y.J., Lee M., Kwon W., Castillo C.F., Del Chiaro M., Marchegiani G., Goh B.K.P., Hijioka S., Majumder S., Nakai Y., Shin A., Jang J.Y. Systematic review on surveillance for non-resected branch-duct intraductal papillary mucinous neoplasms of the pancreas. Pancreatology. 2024; 24 (3): 463–488. https://doi.org/10.1016/j.pan.2024.02.015
40.Guzman-Calderon E., Md B.M., Casellas J.A., Aparicio J.R. Intracystic glucose levels appear useful for diagnosis of pancreatic cystic lesions: a systematic review and meta-analysis. Dig. Dis. Sci. 2022; 67 (6): 2562–2570. https://doi.org/10.1007/s10620-021-07035-w
41.Lopes C.V. Cyst fluid glucose: an alternative to carcinoembryonic antigen for pancreatic mucinous cysts. World J. Gastroenterol. 2019; 25 (19): 2271–2278. https://doi.org/10.3748/wjg.v25.i19.2271
42.Gorris M., Dijk F., Farina A., Halfwerk J.B., Hooijer G.K., Lekkerkerker S.J., Voermans R.P., Wielenga M.C., Besselink M.G., van Hooft J.E. Validation of combined carcinoembryonic antigen and glucose testing in pancreatic cyst fluid to differentiate mucinous from non-mucinous cysts. Surg. Endosc. 2023; 37 (5): 3739–3746. https://doi.org/10.1007/s00464-022-09822-6
43.McCarty T.R., Paleti S., Rustagi T. Molecular analysis of EUSacquired pancreatic cyst fluid for KRAS and GNAS mutations for diagnosis of intraductal papillary mucinous neoplasia and mucinous cystic lesions: a systematic review and meta-analysis. Gastrointest. Endosc. 2021; 93 (5): 1019–1033.e5. https://doi.org/10.1016/j.gie.2020.12.014
44.Singhi A.D., McGrath K., Brand R.E., Khalid A., Zeh H.J., Chennat J.S., Fasanella K.E., Papachristou G.I., Slivka A., Bartlett D.L., Dasyam A.K., Hogg M., Lee K.K., Marsh J.W., Monaco S.E., Ohori N.P., Pingpank J.F., Tsung A., Zureikat A.H., Wald A.I., Nikiforova M.N. Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut. 2018; 67 (12): 2131–2141. https://doi.org/10.1136/gutjnl-2016-313586
45.Степанова Ю.А., Караханян А.А., Шевченко Т.В., Айвазян Х.А., Жаворонкова О.И., Широков В.С., Глотов А.В., Чжао А.В. Цистаденокарцинома печени. Ошибочный диагноз, приведший к выраженной прогрессии заболевания. Высокотехнологическая медицина. 2022; 9 (4): 63–73.
46.Facciorusso A., Del Prete V., Antonino M., Buccino V.R., Wani S. Diagnostic yield of EUS-guided through-the-needle biopsy in pancreatic cysts: a meta-analysis. Gastrointest. Endosc. 2020; 92 (1): 1–8.e3. https://doi.org/10.1016/j.gie.2020.01.038
47.Tacelli M., Celsa C., Magro B., Barchiesi M., Barresi L., Capurso G., Arcidiacono P.G., Camma C., Crino S.F. Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy of pancreatic cystic lesions: systematic review with meta-analysis. Dig. Endosc. 2020; 32 (7): 1018–1030. https://doi.org/10.1111/den.13626
48.Котельников А.Г., Абгарян М.Г., Забежинский Д.А., Подлужный Д.В., Патютко Ю.И. Рак головки поджелудочной железы: современное лечение и дальнейшие перспективы. Вестник хирургической гастроэнтерологии. 2007; 3: 5–16.
49.Polkowski M., Jenssen C., Kaye P., Carrara S., Deprez P., Gines A., Fernandez-Esparrach G., Eisendrath P., Aithal G.P., Arcidiacono P., Barthet M., Bastos P., Fornelli A., Napoleon B., Iglesias-Garcia J., Seicean A., Larghi A., Hassan C., van Hooft J.E., Dumonceau J.M. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy. 2017; 49 (10): 989–1006. https://doi.org/10.1055/s-0043-119219
50.Kromrey M.L., Bulow R., Hubner J., Paperlein C., Lerch M.M., Ittermann T., Volzke H., Mayerle J., Kuhn J.P. Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut. 2018; 67 (1): 138–145. https://doi.org/10.1136/gutjnl-2016-313127
51.Карпов О.Э., Ветшев П.С., Бруслик С.В., Свиридова Т.И., Левчук А.Л., Саржевский В.О., Судиловская В.В. Ультразвуковая абляция (HIFU) в лечении нерезектабельных опухолей поджелудочной железы. Анналы хирургической гепатологии. 2015; 20 (3): 17–23. https://doi.org/10.16931/1995-5464.2015317-23.
52.Allen P.J., D'Angelica M., Gonen M., Jaques D.P., Coit D.G., Jarnagin W.R., DeMatteo R., Fong Y., Blumgart L.H., Brennan M.F. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann. Surg. 2006; 244 (4): 572–582. https://doi.org/10.1097/01.sla.0000237652.84466.54
53.Scheiman J.M., Hwang J.H., Moayyedi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148 (4): 824–848.e22. https://doi.org/10.1053/j.gastro.2015.01.014
54.Correa-Gallego C., Miyasaka Y., Hozaka Y., Nishino H., Kawamoto M., Vieira D.L., Ohtsuka T., Wolfgang C. Surveillance after resection of non-invasive intraductal papillary mucinous neoplasms (IPMN). A systematic review. Pancreatology. 2023; 23 (3): 258–265. https://doi.org/10.1016/j.pan.2023.02.008
55.Ardeshna D.R., Cao T., Rodgers B., Onongaya C., Jones D., Chen W., Koay E.J., Krishna S.G. Recent advances in the diagnostic evaluation of pancreatic cystic lesions. World J. Gastroenterol. 2022; 28 (6): 624–634. https://doi.org/10.3748/wjg.v28.i6.624
56.Ren R., Krishna S.G., Chen W., Frankel W.L., Shen R., Zhao W., Avenarius M.R., Garee J., Caruthers S., Jones D. Activation of the RAS pathway through uncommon BRAF mutations in mucinous pancreatic cysts without KRAS mutation. Mod. Pathol. 2021; 34 (2): 438–444. https://doi.org/10.1016/j.dld.2020.06.038
57.Thosani N., Thosani S., Qiao W., Fleming J.B., Bhutani M.S., Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig. Dis. Sci. 2010; 55 (10): 2756–2766. https://doi.org/10.1007/s10620-010-1361-8
58.Stelow E.B., Stanley M.W., Bardales R.H., Mallery S., Lai R., Linzie B.M., Pambuccian S.E. Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultrasound-guided fineneedle aspiration. Am. J. Clin. Pathol. 2003; 120 (3): 398–404. https://doi.org/10.1309/CEPK-542W-3885-2LP8
59.Pitman M.B., Centeno B.A., Reid M.D., Siddiqui M.T., Layfield L.J., Perez-Machado M., Weynand B., Stelow E.B., Lozano M.D., Fukushima N., Cree I.A., Mehrotra R., Schmitt F.C., Field A.S. The World Health Organization Reporting System for Pancreaticobiliary Cytopathology. Acta Cytol. 2023; 67 (3): 304–320. https://doi.org/10.1159/000527912
60.International Academy of Cytology-International Agency for Research on Cancer-World Health Organization Joint Editorial Board. WHO Reporting System for Pancreaticobiliary Cytopathology. Vol. 2. 1st ed. International Agency for Research on Cancer; 2022. https://doi.org/10.1007/978-92-832-4518-6
61.Vilela A., Quingalahua E., Vargas A., Hawa F., Shannon C., Carpenter E.S., Shi J., Krishna S.G., Lee U.J., Chalhoub J.M., Machicado J.D. Global prevalence of pancreatic cystic lesions in the general population on magnetic resonance imaging: a systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2024; 22 (9): 1798–1809.e6. https://doi.org/10.1016/j.cgh.2024.02.018
62.Smith A.L., Abdul-Karim F.W., Goyal A. Cytologic categorization of pancreatic neoplastic mucinous cysts with an assessment of the risk of malignancy: a retrospective study based on the Papanicolaou Society of Cytopathology guidelines. Cancer Cytopathol. 2016; 124 (4): 285–293. https://doi.org/10.1002/cncy.21657
63.Pfluger M.J., Jamouss K.T., Afghani E., Lim S.J., Rodriguez Franco S., Mayo H., Spann M., Wang H., Singhi A., Lennon A.M., Wood L.D. Predictive ability of pancreatic cyst fluid biomarkers: a systematic review and meta-analysis. Pancreatology. 2023; 23 (7): 868–877. https://doi.org/10.1016/j.pan.2023.05.005
64.Hoda R.S., Arpin R.N. 3rd, Rosenbaum M.W., Pitman M.B. Risk of malignancy associated with diagnostic categories of the proposed World Health Organization International System for Reporting Pancreaticobiliary Cytopathology. Cancer Cytopathol. 2022; 130 (3): 195–201. https://doi.org/10.1002/cncy.22514
65.Serinelli S., Khurana K.K. Intraductal papillary mucinous neoplasms of the pancreas: cytologic-histologic correlation study and evaluation of the cytologic accuracy in identifying highgrade dysplasia/invasive adenocarcinoma. Cytojournal. 2024; 21: 6. https://doi.org/10.25259/Cytojournal_71_2023
66.Sinha S.R., Mondal S., Akhtar M.J., Singh R.K., Prakash P. Evaluating carcinoembryonic antigen and glucose levels in pancreatic cyst fluid for mucinous versus non-mucinous differentiation. Cureus. 2024; 16 (6): e62686. https://doi.org/10.7759/cureus.62686
67.Кошель А.П., Дроздов Е.С., Дибина Т.В., Клаков С.С., Миронова Е.Б., Ракина Ю.Ю. Комбинированный способ дифференциальной диагностики кистозных неоплазий поджелудочной железы. Сибирский онкологический журнал. 2018; 17 (6): 27–34. https://doi.org/10.21294/1814-4861-2018-17-6-27-34.
68.Bedi M.M., Gandhi M.D., Jacob G., Lekha V., Venugopal A., Ramesh H. CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit? Indian J. Gastroenterol. 2009; 28 (1): 24–27. https://doi.org/10.1007/s12664-009-0005-4
69.Haglund C., Lundin J., Kuusela P., Roberts P.J. CA 242, a new tumour marker for pancreatic cancer: a comparison with CA 19-9, CA 50 and CEA. Br. J. Cancer. 1994; 70 (3): 487–492. https://doi.org/10.1038/bjc.1994.332
70.Shibata H., Ohike N., Norose T., Isobe T., Suzuki R., Imai H., Shiokawa A., Aoki T., Murakami M., Mizukami H., Tanaka J.I., Takimoto M. Mucinous cystic neoplasms lined by abundant mucinous epithelium frequently involve KRAS mutations and malignant progression. Anticancer Res. 2017; 37 (12): 7063–7068. https://doi.org/10.21873/anticanres.12178
71.Conner J.R., Marino-Enriquez A., Mino-Kenudson M., Garcia E., Pitman M.B., Sholl L.M., Srivastava A., Doyle L.A. Genomic characterization of low- and high-grade pancreatic mucinous cystic neoplasms reveals recurrent KRAS alterations in ''high-risk'' lesions. Pancreas. 2017; 46 (5): 665–671. https://doi.org/10.1097/MPA.0000000000000805
72.Sakhdari A., Moghaddam P.A., Ok C.Y., Walter O., Tomaszewicz K., Caporelli M.L., Meng X., LaFemina J., Whalen G., Belkin E., Zivny J., Wassef W., Woda B.A., Hutchinson L.M., Cosar E.F. Somatic molecular analysis augments cytologic evaluation of pancreatic cyst fluids as a diagnostic tool. Oncotarget. 2019; 10 (40): 4026–4037. https://doi.org/10.18632/oncotarget.26999
73.Jang K.T., Park S.M., Basturk O., Bagci P., Bandyopadhyay S., Stelow E.B., Walters D.M., Choi D.W., Choi S.H., Heo J.S., Sarmiento J.M., Reid M.D., Adsay V. Clinicopathologic characteristics of 29 invasive carcinomas arising in 178 pancreatic mucinous cystic neoplasms with ovarian-type stroma: implications for management and prognosis. Am. J. Surg. Pathol. 2015; 39 (2): 179–187. https://doi.org/10.1097/PAS.0000000000000357
74.Yamao K., Yanagisawa A., Takahashi K., Kimura W., Doi R., Fukushima N., Ohike N., Shimizu M., Hatori T., Nobukawa B., Hifumi M., Kobayashi Y., Tobita K., Tanno S., Sugiyama M., Miyasaka Y., Nakagohri T., Yamaguchi T., Hanada K., Abe H., Tada M., Fujita N., Tanaka M. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan Pancreas Society. Pancreas. 2011; 40 (1): 67–71. https://doi.org/10.1097/MPA.0b013e3181f749d3
75.Prabhakar L.P., Orchard T.F., Hughes S., van Heerden J.A., DiMagno E.P. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann. Surg. 2000; 231 (2): 205–212. https://doi.org/10.1097/00000658-200002000-00009
76.Munigala S., Gelrud A., Agarwal B. Risk of pancreatic cancer in patients with pancreatic cyst. Gastrointest. Endosc. 2016; 84 (1): 81–86. https://doi.org/10.1016/j.gie.2015.10.030
77.Паклина О.В., Сетдикова Г.Р., Чекмарева И.А. Морфологическая характеристика кистозных опухолей поджелудочной железы. Анналы хирургической гепатологии. 2012; 17 (1): 26–34.
78.Kuboki Y., Shimizu K., Hatori T., Yamamoto M., Shibata N., Shiratori K., Furukawa T. Molecular biomarkers for progression of intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 2015; 44 (2): 227–235. https://doi.org/10.1097/MPA.0000000000000253
79.Furukawa T., Kuboki Y., Tanji E., Yoshida S., Hatori T., Yamamoto M., Shibata N., Shimizu K., Kamatani N., Shiratori K. Whole-exome sequencing uncovers frequent GNAS mutations in intraductal papillary mucinous neoplasms of the pancreas. Sci. Rep. 2011; 1: 161. https://doi.org/10.1038/srep00161
80.Jais B., Rebours V., Malleo G., Salvia R., Fontana M., Maggino L., Bassi C., Manfredi R., Moran R., Lennon A.M., Zaheer A., Wolfgang C., Hruban R., Marchegiani G., Fernandez Del Castillo C., Brugge W., Ha Y., Kim M.H., Oh D., Hirai I., Kimura W., Jang J.Y., Kim S.W., Jung W., Kang H., Song S.Y., Kang C.M., Lee W.J., Crippa S., Falconi M., Gomatos I., Neoptolemos J., Milanetto A.C., Sperti C., Ricci C., Casadei R., Bissolati M., Balzano G., Frigerio I., Girelli R., Delhaye M., Bernier B., Wang H., Jang K.T., Song D.H., Huggett M.T., Oppong K.W., Pererva L., Kopchak K.V., Del Chiaro M., Segersvard R., Lee L.S., Conwell D., Osvaldt A., Campos V., Aguero Garcete G., Napoleon B., Matsumoto I., Shinzeki M., Bolado F., Fernandez J.M., Keane M.G., Pereira S.P., Acuna I.A., Vaquero E.C., Angiolini M.R., Zerbi A., Tang J., Leong R.W., Faccinetto A., Morana G., Petrone M.C., Arcidiacono P.G., Moon J.H., Choi H.J., Gill R.S., Pavey D., Ouaissi M., Sastre B., Spandre M., De Angelis C.G., Rios-Vives M.A., Concepcion-Martin M., Ikeura T., Okazaki K., Frulloni L., Messina O., Levy P. 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). Gut. 2016; 65 (2): 305–312. https://doi.org/10.1136/gutjnl-2015-309638
81.Brugge W.R., Lewandrowski K., Lee-Lewandrowski E., Centeno B.A., Szydlo T., Regan S., del Castillo C.F., Warshaw A.L. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004; 126 (5): 1330– 1336. https://doi.org/10.1053/j.gastro.2004.02.013
82.Cizginer S., Turner B., Bilge A.R., Karaca C., Pitman M.B., Brugge W.R. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas. 2011; 40 (7): 1024–1028. https://doi.org/10.1097/MPA.0b013e31821bd62f
83.Ribaldone D.G., Bruno M., Gaia S., Cantamessa A., Bragoni A., Caropreso P., Sacco M., Fagoonee S., Saracco G.M., De Angelis C. Differential diagnosis of pancreatic cysts: a prospective study on the role of intra-cystic glucose concentration. Dig. Liver Dis. 2020; 52 (9): 1026–1032. https://doi.org/10.1016/j.dld.2020.06.038
84.Mohan B.P., Madhu D., Khan S.R., Kassab L.L., Ponnada S., Chandan S., Facciorusso A., Crino S.F., Barresi L., McDonough S., Adler D.G. Intracystic glucose levels in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis. J. Clin. Gastroenterol. 2022; 56 (2): e131–e136. https://doi.org/10.1097/MCG.0000000000001507
85.Jeon J.H., Kim J.H., Joo I., Lee S., Choi S.Y., Han J.K. Transabdominal ultrasound detection of pancreatic cysts incidentally detected at CT, MRI, or endoscopic ultrasound. AJR Am. J. Roentgenol. 2018; 210 (3): 518–525. https://doi.org/10.2214/AJR.17.18449
86.Stern L., Schuette M., Goetz M.R., Nitschke C., Bardenhagen J., Scognamiglio P., Stuben B.O., Calavrezos L., Amin T., Heumann A., Lohse A.W., de Heer G., Izbicki J.R., Uzunoglu F.G. Perioperative management of pancreatic exocrine insufficiency-evidence-based proposal for a paradigm shift in pancreatic surgery. HPB (Oxford). 2024; 26 (1): 117–124. https://doi.org/10.1016/j.hpb.2023.09.003
87.Егоров В.И., Вишневский В.А., Щеголев А.И., Кармазановский Г.Г., Шевченко Т.В., Яшина Н.И., Дубова Е.А., Плотникова Л.С., Мелехина О.В., Козырин И.А. Резекцияподжелудочной железы при неинвазивных внутрипротоковых папиллярных муцинозных опухолях. Хирургия. Журнал им. Н.И. Пирогова. 2009; 3: 53–60.
88.Choi S.H., Park S.H., Kim K.W., Lee J.Y., Lee S.S. Progression of unresected intraductal papillary mucinous neoplasms of the pancreas to cancer: a systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2017; 15 (10): 1509–1520.e4. https://doi.org/10.1016/j.cgh.2017.03.020
89.Lensing R.J., Bipat S. Incidences of pancreatic malignancy and mortality in patients with untreated branch-duct intraductal papillary mucinous neoplasms undergoing surveillance: a systematic review. Pancreas. 2017; 46 (9): 1098–1110. https://doi.org/10.1097/MPA.0000000000000907
90.Lee S.W., Shim S.R., Jeong S.Y., Kim S.J. Comparison of preoperative imaging modalities for the assessment of malignant potential of pancreatic cystic lesions: a network meta-analysis. Clin. Nucl. Med. 2022; 47 (10): 849–855. https://doi.org/10.1097/RLU.0000000000004323
91.Wood L.D., Adsay N.V., Basturk O., Brosens L.A.A., Fukushima N., Hong S.M., Kim S.J., Lee J.W., Luchini C., Noe M., Pitman M.B., Scarpa A., Singhi A.D., Tanaka M., Furukawa T. Systematic review of challenging issues in pathology of intraductal papillary mucinous neoplasms. Pancreatology. 2023; 23 (7): 878–891. https://doi.org/10.1016/j.pan.2023.08.002
92.Frankel T.L., LaFemina J., Bamboat Z.M., D'Angelica M.I., DeMatteo R.P., Fong Y., Kingham T.P., Jarnagin W.R., Allen P.J. Dysplasia at the surgical margin is associated with recurrence after resection of non-invasive intraductal papillary mucinous neoplasms. HPB (Oxford). 2013; 15 (10): 814–821. https://doi.org/10.1111/hpb.12137
93.Li S.Y., Wang Z.J., Pan C.Y., Wu C., Li Z.S., Jin Z.D., Wang K.X. Comparative performance of endoscopic ultrasoundbased techniques in patients with pancreatic cystic lesions: a network meta-analysis. Am. J. Gastroenterol. 2023; 118 (2): 243–255. https://doi.org/10.14309/ajg.0000000000002088
94.Ohno E., Balduzzi A., Hijioka S., De Pastena M., Marchegiani G., Kato H., Takenaka M., Haba S., Salvia R. Association of high-risk stigmata and worrisome features with advanced neoplasia in intraductal papillary mucinous neoplasms (IPMN): a systematic review. Pancreatology. 2024; 24 (1): 48–61. https://doi.org/10.1016/j.pan.2023.12.002
95.Nilsson L.N., Keane M.G., Shamali A., Millastre Bocos J., Marijinissen van Zanten M., Antila A., Verdejo Gil C., Del Chiaro M., Laukkarinen J. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology. 2016; 16 (6): 1028–1036. https://doi.org/10.1016/j.pan.2016.09.011
96.Reid M.D., Choi H.J., Memis B., Krasinskas A.M., Jang K.T., Akkas G., Maithel S.K., Sarmiento J.M., Kooby D.A., Basturk O., Adsay V. 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”. Am. J. Surg. Pathol. 2015; 39 (12): 1597–1610. https://doi.org/10.1097/PAS.0000000000000559
97.Цвиркун В.В., Буриев И.М., Глабай В.П. Резолюция XVI Международного конгресса хирургов-гепатологов. Анналы хирургической гепатологии. 2009; 14 (4): 112–115.
98.Roch A.M., Ceppa E.P., DeWitt J.M., Al-Haddad M.A., House M.G., Nakeeb A., Schmidt C.M. International Consensus Guidelines parameters for the prediction of malignancy in intraductal papillary mucinous neoplasm are not properly weighted and are not cumulative. HPB (Oxford). 2014; 16 (10): 929–935. https://doi.org/10.1111/hpb.12305
99.Tyutyunnik P., Klompmaker S., Lombardo C., Lapshyn H., Menonna F., Napoli N., Wellner U., Izrailov R., Baychorov M., Besselink M.G., Abu Hilal M., Fingerhut A., Boggi U., Keck T., Khatkov I. European Consortium on Minimally Invasive Pancreatic Surgery. Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy. Surg. Endosc. 2022; 36 (2): 1515–1526. https://doi.org/10.1007/s00464-021-08439-5
100.Кармазановский Г.Г. МСКТ- и МРТ-диагностика кистозных опухолей поджелудочной железы. Анналы хирургической гепатологии. 2012; 17 (1): 11–16.
101.Neoptolemos J.P., Palmer D.H., Ghaneh P., Psarelli E.E., Valle J.W., Halloran C.M., Faluyi O., O'Reilly D.A., Cunningham D., Wadsley J., Darby S., Meyer T., Gillmore R., Anthoney A., Lind P., Glimelius B., Falk S., Izbicki J.R., Middleton G.W., Cummins S., Ross P.J., Wasan H., McDonald A., Crosby T., Ma Y.T., Patel K., Sherriff D., Soomal R., Borg D., Sothi S., Hammel P., Hackert T., Jackson R., Buchler M.W. European Study Group for Pancreatic Cancer. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017; 389 (10073): 1011–1024. https://doi.org/10.1016/S0140-6736(16)32409-6
102.Conroy T., Hammel P., Hebbar M., Ben Abdelghani M., Wei A.C., Raoul J.L., Chone L., Francois E., Artru P., Biagi J.J., Lecomte T., Assenat E., Faroux R., Ychou M., Volet J., Sauvanet A., Breysacher G., Di Fiore F., Cripps C., Kavan P., Texereau P., Bouhier-Leporrier K., Khemissa-Akouz F., Legoux J.L., Juzyna B., Gourgou S., O'Callaghan C.J., Jouffroy-Zeller C., Rat P., Malka D., Castan F., Bachet J.B. Canadian Cancer Trials Group and the Unicancer-GI–PRODIGE Group. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N. Engl. J. Med. 2018; 379 (25): 2395–2406. https://doi.org/10.1056/NEJMoa1809775.

International consensus on diagnosing and managing pancreatic serous and mucinous cystic neoplasms

In 2023, with the approval of the leadership of the Hepato-Pancreato-Biliary Association of Commonwealth of Independent States, a consensus study was initiated and conducted on the diagnosis, management, and follow-up of patients with serous and mucinous neoplasms of the pancreas. Based on an extensive literature review, responses to each of the 22 questions posed were formulated and compiled into a Consensus Document. A total of 44 experts representing 27 institutions across 9 countries participated in the preparation of the Consensus. The Delphi method was employed for voting, and ultimately, including the results of votes on selected statements during the final conference, consensus was achieved on all questions.

Keywords:
поджелудочная железа, неоплазия, кистозное новообразование, IPMN, муцинозная цистаденома, серозная цистаденома, pancreas, neoplasia, cystic tumor, IPMN, mucinous cystadenoma, serous cystadenoma