{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:06:08Z","timestamp":1780088768163,"version":"3.54.0"},"reference-count":88,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T00:00:00Z","timestamp":1746316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T00:00:00Z","timestamp":1746316800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>Intraductal papillary mucinous neoplasms (IPMNs) progress from low\u2010grade dysplasia to high\u2010grade dysplasia (HGD) or invasive carcinoma (IC). High diagnostic accuracy is critical for surgical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched Medline, Embase, and Cochrane Library from January 1, 2015, to January 27, 2025. Eligible studies reported on resected IPMNs, assessing diagnostic features for HGD\/IC. Two reviewers screened articles, extracted data, and assessed bias using the Newcastle\u2013Ottawa scale. Descriptive statistics summarized outcomes. The performance of worrisome features (WFs) and high\u2010risk stigmata (HRS) based on International Association of Pancreatology guidelines were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the 53 studies, 12\u2009953 patients were included. HRS including obstructive jaundice and enhancing mural nodules \u22655mm showed robust specificity for\u00a0HGD\/IC, while main pancreatic duct size \u226510mm showed variable diagnostic accuracy. WFs such as cyst size \u22653\u2009cm performed poorly, while cyst growth rate &gt;3.5\u2009mm\/year demonstrated higher sensitivity (88%) and specificity (91%). Although rare, abrupt caliber change with distal atrophy was a robust predictor of malignancy (median odds ratio: 3.01). Acute pancreatitis and lymphadenopathy displayed variable value. Incremental improvement in diagnostic accuracy was observed with additional HRS or WFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current diagnostic markers are valuable but provide limited guidance for surgical decision\u2010making in IPMNs, highlighting the need for further refinement of diagnostic tools.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.12150","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T01:44:23Z","timestamp":1746409463000},"page":"8-20","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical and radiological predictive features for high\u2010grade and invasive carcinoma in intraductal papillary mucinous neoplasms: A systematic 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