ArticleAnnals of surgical oncology2026
Impact of Next-Generation Sequencing on Surgical Decision-Making in Branch-Duct IPMN.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundManaging branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging, as guideline criteria (worrisome features/high-risk stigmata) and nomograms often leave uncertainty. Next-generation sequencing (NGS) may provide actionable molecular information that influences clinical decision-making.
methodsWe conducted a national, vignette-based decision-impact study involving 132 clinicians (gastroenterologists and surgeons). Four complex BD-IPMN vignettes (each with two to four worrisome features) were evaluated twice: pre-NGS and post-NGS after disclosure of either a high-risk mutation (positive) or its absence (negative). The primary endpoint was the within-physician change in management in the NGS-concordant direction (NGS+ surveillance to surgery; NGS- surgery to surveillance) assessed using McNemar's test and mixed-effects logistic regression. Secondary endpoints included change in decision confidence, inter-physician agreement (Fleiss' κappa), and practitioner factors.
resultsNGS significantly changed management in all vignettes (all p < 0.001): with NGS-, surgical plans shifted to surveillance (43% in distal pancreatectomy; 61% in pancreatoduodenectomy scenarios); with NGS+, surveillance shifted to surgery (90% and 72%, respectively; both p < 0.001). In mixed-model, post-NGS reduced surgery in NGS- cases (odd ratio [OR] 0.30, 95%confidence interval [CI] 0.16-0.57) and the post-NGS effect was strongly amplified in NGS+ cases (interaction OR 76.51, 95%CI 26.47-221.13). Population-averaged probabilities of choosing surgery shifted from 20% to 7% (NGS-) and 42% to 94% (NGS+). Decision confidence increased (proportional-odds OR 4.66, 95%CI 3.62-6.02, p < 0.0001). Inter-physician agreement rose from κ = 0.044 (95%CI 0.033-0.055) pre-NGS to κ = 0.590 (95%CI 0.580-0.601) post-NGS (p < 2×10
conclusionsIn complex BD-IPMN scenarios, NGS significantly influences clinician decision-making and reduces inter-physician variability. These findings support its role as a decision-support tool.
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