Pub Date : 2026-01-07DOI: 10.1001/jamasurg.2025.5847
Anai N Kothari
{"title":"Suitability of Large Language Models and Predicting Case Duration-Reply.","authors":"Anai N Kothari","doi":"10.1001/jamasurg.2025.5847","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5847","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"82 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1001/jamasurg.2025.5844
Jordan Prosky,Judy Wawira Gichoya
{"title":"Suitability of Large Language Models and Predicting Case Duration.","authors":"Jordan Prosky,Judy Wawira Gichoya","doi":"10.1001/jamasurg.2025.5844","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5844","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"39 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1001/jamasurg.2025.4916
Kaelyn C Cummins, Allan Tsung
{"title":"Total Pancreatectomy-Still a Last-Resort Procedure.","authors":"Kaelyn C Cummins, Allan Tsung","doi":"10.1001/jamasurg.2025.4916","DOIUrl":"10.1001/jamasurg.2025.4916","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"58"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1001/jamasurg.2025.5416
{"title":"Change to Open Access.","authors":"","doi":"10.1001/jamasurg.2025.5416","DOIUrl":"10.1001/jamasurg.2025.5416","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"104"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12631564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ImportanceDespite the recovery advantages of minimally invasive surgical techniques, moderate to severe pain after laparoscopic colorectal surgery is a common barrier to improving postoperative recovery quality.ObjectiveTo evaluate whether intrathecal morphine (ITM) combined with transversus abdominis plane block (TAPB) improves postoperative recovery quality after laparoscopic colorectal surgery.Design, Setting, and ParticipantsThis prospective, double-blind randomized clinical trial was conducted at Sun Yat-sen University Cancer Center between October 15, 2024, and February 15, 2025. Adults scheduled for elective laparoscopic colorectal surgery were randomized 1:1 to ITM or saline placebo. Data were analyzed from March 1, 2025, to March 31, 2025.InterventionsBoth groups received liposomal bupivacaine for TAPB as part of standard enhanced recovery after surgery (ERAS) protocol. The intervention group received ITM, 3 µg/kg, while the control group received intrathecal normal saline.Main Outcomes and MeasuresThe primary outcome was the Quality of Recovery 15 (QoR-15) score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores, cumulative opioid consumption (in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, incidence of adverse effects, and length of hospital stay.ResultsA total of 252 patients were included in the intention-to-treat analysis (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). At 24 hours postoperatively, the intervention group had significantly higher mean (SE) QoR-15 scores compared to the control group (114.95 [1.04] vs 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P < .001), indicating better recovery quality. Postoperative mean (SD) morphine consumption was lower in the intervention group compared to the control group (4.4 [6.4] MME vs 10.4 [11.1] MME; mean difference, -6.59; 95% CI, -8.88 to -4.31; P < .001). The intervention group also had a reduced incidence of nausea (23.8% vs 37.3%; adjusted risk difference, -15.06%; 95% CI, -26.60% to -3.52%; P = .01), but a high incidence of pruritus was observed in the intervention group (19.0% vs 3.2%; adjusted risk difference, 15.08%; 95% CI, 7.26%-22.90%; P < .001).Conclusions and RelevancePer the results of this randomized clinical trial, in laparoscopic colorectal surgery, ITM combined with TAPB can significantly enhance early postoperative recovery and analgesia, albeit with an increased risk of pruritus. This strategy may be a valuable component of multimodal analgesia regimens following laparoscopic colorectal surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT06636864.
尽管微创手术技术具有恢复优势,但腹腔镜结直肠手术后中度至重度疼痛是提高术后恢复质量的常见障碍。目的评价鞘内吗啡(ITM)联合经腹平面阻滞(TAPB)对腹腔镜结直肠癌术后恢复质量的影响。设计、环境和参与者这项前瞻性、双盲随机临床试验于2024年10月15日至2025年2月15日在中山大学癌症中心进行。计划进行择期腹腔镜结直肠手术的成人按1:1随机分为ITM组或生理盐水安慰剂组。数据分析时间为2025年3月1日至2025年3月31日。干预措施:两组均接受布比卡因脂质体治疗TAPB,作为标准手术后增强恢复(ERAS)方案的一部分。干预组给予ITM,剂量为3µg/kg,对照组给予鞘内生理盐水。主要观察指标术后24小时恢复质量15 (QoR-15)评分为主要观察指标。次要结局包括术后疼痛评分、阿片类药物累积消耗(吗啡毫克当量[MME])、第一次放屁时间、第一次下床时间、不良反应发生率和住院时间。结果共有252例患者被纳入意向治疗分析(平均[SD]年龄58.4[11.1]岁,女性112例[44.4%])。术后24小时,干预组QoR-15平均评分(SE)明显高于对照组(114.95 [1.04]vs 102.22[0.76];平均差值12.21;95% CI, 9.91 ~ 14.51; P <。001),表明恢复质量较好。干预组术后平均吗啡用量(SD)低于对照组(4.4 [6.4]MME vs 10.4 [11.1] MME;平均差异为-6.59;95% CI, -8.88 ~ -4.31; P < .001)。干预组恶心发生率也降低(23.8% vs 37.3%),校正风险差为-15.06%,95% CI为-26.60% ~ -3.52%,P =。干预组瘙痒的发生率较高(19.0% vs 3.2%,校正风险差为15.08%,95% CI为7.26% ~ 22.90%,P < 0.001)。结论及相关性本随机临床试验结果显示,在腹腔镜结直肠手术中,ITM联合TAPB可显著增强术后早期恢复和镇痛,但瘙痒风险增加。该策略可能是腹腔镜结直肠手术后多模式镇痛方案的一个有价值的组成部分。临床试验注册号:NCT06636864。
{"title":"Intrathecal Morphine for Enhanced Recovery After Laparoscopic Colorectal Surgery: A Randomized Clinical Trial.","authors":"Liquan Zheng,Yali Lu,Xiaofan Lu,Lizhen You,Chuanchuan Yu,Jielan Lai,Mei Xu,Manxiu Xie,Ying Xiao,Renchun Lai","doi":"10.1001/jamasurg.2025.5699","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5699","url":null,"abstract":"ImportanceDespite the recovery advantages of minimally invasive surgical techniques, moderate to severe pain after laparoscopic colorectal surgery is a common barrier to improving postoperative recovery quality.ObjectiveTo evaluate whether intrathecal morphine (ITM) combined with transversus abdominis plane block (TAPB) improves postoperative recovery quality after laparoscopic colorectal surgery.Design, Setting, and ParticipantsThis prospective, double-blind randomized clinical trial was conducted at Sun Yat-sen University Cancer Center between October 15, 2024, and February 15, 2025. Adults scheduled for elective laparoscopic colorectal surgery were randomized 1:1 to ITM or saline placebo. Data were analyzed from March 1, 2025, to March 31, 2025.InterventionsBoth groups received liposomal bupivacaine for TAPB as part of standard enhanced recovery after surgery (ERAS) protocol. The intervention group received ITM, 3 µg/kg, while the control group received intrathecal normal saline.Main Outcomes and MeasuresThe primary outcome was the Quality of Recovery 15 (QoR-15) score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores, cumulative opioid consumption (in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, incidence of adverse effects, and length of hospital stay.ResultsA total of 252 patients were included in the intention-to-treat analysis (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). At 24 hours postoperatively, the intervention group had significantly higher mean (SE) QoR-15 scores compared to the control group (114.95 [1.04] vs 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P < .001), indicating better recovery quality. Postoperative mean (SD) morphine consumption was lower in the intervention group compared to the control group (4.4 [6.4] MME vs 10.4 [11.1] MME; mean difference, -6.59; 95% CI, -8.88 to -4.31; P < .001). The intervention group also had a reduced incidence of nausea (23.8% vs 37.3%; adjusted risk difference, -15.06%; 95% CI, -26.60% to -3.52%; P = .01), but a high incidence of pruritus was observed in the intervention group (19.0% vs 3.2%; adjusted risk difference, 15.08%; 95% CI, 7.26%-22.90%; P < .001).Conclusions and RelevancePer the results of this randomized clinical trial, in laparoscopic colorectal surgery, ITM combined with TAPB can significantly enhance early postoperative recovery and analgesia, albeit with an increased risk of pruritus. This strategy may be a valuable component of multimodal analgesia regimens following laparoscopic colorectal surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT06636864.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"22 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1001/jamasurg.2025.5711
Armaan K Malhotra,Husain Shakil,Vishwathsen Karthikeyan,Christopher S Lozano,Christopher D Witiw,Jefferson R Wilson,Avery B Nathens
{"title":"Forecasting the Impact of Fully Automated Vehicle Adoption on US Road Traffic Injuries.","authors":"Armaan K Malhotra,Husain Shakil,Vishwathsen Karthikeyan,Christopher S Lozano,Christopher D Witiw,Jefferson R Wilson,Avery B Nathens","doi":"10.1001/jamasurg.2025.5711","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5711","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1001/jamasurg.2025.5606
Giammauro Berardi,Alessandro Cucchetti,Giuseppe Maria Ettorre
{"title":"Sample Size Calculation and Protocol Deviations in the PREHEP Trial-Reply.","authors":"Giammauro Berardi,Alessandro Cucchetti,Giuseppe Maria Ettorre","doi":"10.1001/jamasurg.2025.5606","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5606","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"32 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1001/jamasurg.2025.5692
Amudhan Kannan,Gilbert Z Murimwa,John C Mansour,Zachary A Whitham,Alex R Jones,Megha K Sheth,Ali Abbas,Abhi Deverakonda,Tarek Sawas,Daniel J Ellis,Hendrikus S Vanderveldt,Veronica Coleman,Samantha Foley,Anna Tavakkoli,Markus Goldschmeidt,Naveen Rajamohan,Gaurav Khatri,Randall E Brand,Marina N Nikiforova,Alessandro Paniccia,Amer H Zureikat,Kenneth K W Lee,Jason B Fleming,Herbert J Zeh,Nisa M Kubiliun,Aatur D Singhi,Patricio M Polanco
ImportanceStudying the molecular profiles of mixed-type and branch-duct (BD) intraductal papillary mucinous neoplasms (IPMNs) is important to understand the underlying biological basis for higher malignant potential of mixed-type IPMNs.ObjectiveTo compare mutation patterns in mixed-type vs BD-IPMNs through cyst fluid next-generation sequencing (NGS) analysis using PancreaSeq NGS.Design, Setting, and ParticipantsFor this cohort study, pancreatic cyst fluid specimens from 31 medical centers were sent to a centralized NGS lab for analysis between January 2018 and February 2020. Patients with IPMNs (based on KRAS and GNAS mutant status) and with available main pancreatic duct (MPD) size data were included. Patients with main-duct IPMNs and with MPD 10 mm or greater were excluded. Mixed-type IPMNs were defined as IPMNs with an MPD of 5 to 9 mm, and BD-IPMNs were defined as IPMNs with an MPD less than 5 mm. High-risk mutations (HRMs) were categorized as alterations in TP53, SMAD4, CTNNB1, and mTOR genes. Advanced neoplasia was defined as IPMNs with invasive carcinoma or high-grade dysplasia. Data were analyzed from June 1 to 5, 2025.Main Outcomes and MeasuresPrimary outcomes included rates of HRMs and the co-occurrence of 2 or more HRMs in mixed-type IPMNs and BD-IPMNs.ResultsAmong 674 patients with IPMNs, 202 had mixed-type IPMN, and 472 had BD-IPMN. There were 379 female patients (56.2%) and 295 male patients (43.8%); the mean (SD) age was 70.3 (9.6) years. HRMs were observed in 106 patients (16%), with TP53, SMAD4, and MTOR mutations more common in mixed-type IPMNs. Of the 674 patients, 167 patients underwent surgical resection, and these 167 patients had final surgical pathology available. Overall, mixed-type IPMNs had significantly higher rates of HRMs (62 [31%] vs 44 [9.3%]; P < .001) and co-occurrence of 2 or more HRMs (25 [12.4%] vs 14 [3%]; P < .001) compared with BD-IPMNs. On multivariate logistic regression, mixed-type IPMNs were independently associated with HRMs (odds ratio, 3.42; 95% CI, 1.72-6.82). Preoperative NGS detection of HRMs showed 90% sensitivity, 100% specificity, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 86% for predicting advanced neoplasia in mixed-type IPMNs. The presence of any worrisome feature or high-risk stigmata showed a sensitivity of 100%, very low specificity of 13.3%, PPV of 67%, and NPV of 100%.Conclusions and RelevanceThis study found that mixed-type IPMNs are more likely to harbor HRMs associated with advanced neoplasia. Cyst fluid NGS is highly sensitive and specific for predicting advanced neoplasia in patients with mixed-type IPMNs and should therefore be considered to help upgrade or downgrade risk based on the presence or absence of other worrisome features.
研究混合型和支管(BD)导管内乳头状粘液瘤(IPMNs)的分子特征对于了解混合型IPMNs高恶性潜能的潜在生物学基础非常重要。目的通过对囊肿液下一代测序(NGS)分析,比较混合型和BD-IPMNs的突变模式。设计、环境和参与者在本队列研究中,来自31个医疗中心的胰腺囊肿液标本在2018年1月至2020年2月期间被送到NGS集中实验室进行分析。IPMNs患者(基于KRAS和GNAS突变状态)和可用的主胰管(MPD)大小数据被纳入研究。排除主管IPMNs和MPD大于等于10mm的患者。混合型IPMNs定义为MPD为5 ~ 9mm的IPMNs, bd型IPMNs定义为MPD小于5mm的IPMNs。高危突变(HRMs)被归类为TP53、SMAD4、CTNNB1和mTOR基因的改变。晚期瘤变定义为IPMNs伴浸润性癌或高级别不典型增生。数据分析时间为2025年6月1日至5日。主要结局和测量方法主要结局包括混合型IPMNs和BD-IPMNs中hrm的发生率和合并2种或2种以上hrm的发生率。结果674例IPMN患者中,混合型IPMN 202例,bd型IPMN 472例。其中女性379例(56.2%),男性295例(43.8%);平均(SD)年龄70.3(9.6)岁。106例(16%)患者观察到hrm, TP53、SMAD4和MTOR突变在混合型ipmn中更为常见。在674例患者中,167例患者接受了手术切除,这167例患者的最终手术病理可查。总体而言,混合型IPMNs的hrm率明显更高(62例[31%]vs 44例[9.3%];001)和合并出现2个或更多hrm (25 [12.4%] vs 14 [3%]; P < 0.001)。001)与BD-IPMNs相比。在多变量logistic回归中,混合型ipmn与hrm独立相关(优势比3.42;95% CI 1.72-6.82)。术前NGS检测HRMs的敏感性为90%,特异性为100%,阳性预测值(PPV)为100%,阴性预测值(NPV)为86%,用于预测混合型ipmn的晚期肿瘤。任何令人担忧的特征或高风险柱头的存在敏感性为100%,极低特异性为13.3%,PPV为67%,NPV为100%。结论和相关性本研究发现,混合型IPMNs更容易发生与晚期肿瘤相关的hrm。囊肿液NGS对于预测混合型IPMNs患者的晚期肿瘤具有高度敏感性和特异性,因此应考虑根据是否存在其他令人担忧的特征来帮助提高或降低风险。
{"title":"Molecular Analysis of Mixed-Type and Branch-Duct Intraductal Papillary Mucinous Neoplasms.","authors":"Amudhan Kannan,Gilbert Z Murimwa,John C Mansour,Zachary A Whitham,Alex R Jones,Megha K Sheth,Ali Abbas,Abhi Deverakonda,Tarek Sawas,Daniel J Ellis,Hendrikus S Vanderveldt,Veronica Coleman,Samantha Foley,Anna Tavakkoli,Markus Goldschmeidt,Naveen Rajamohan,Gaurav Khatri,Randall E Brand,Marina N Nikiforova,Alessandro Paniccia,Amer H Zureikat,Kenneth K W Lee,Jason B Fleming,Herbert J Zeh,Nisa M Kubiliun,Aatur D Singhi,Patricio M Polanco","doi":"10.1001/jamasurg.2025.5692","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5692","url":null,"abstract":"ImportanceStudying the molecular profiles of mixed-type and branch-duct (BD) intraductal papillary mucinous neoplasms (IPMNs) is important to understand the underlying biological basis for higher malignant potential of mixed-type IPMNs.ObjectiveTo compare mutation patterns in mixed-type vs BD-IPMNs through cyst fluid next-generation sequencing (NGS) analysis using PancreaSeq NGS.Design, Setting, and ParticipantsFor this cohort study, pancreatic cyst fluid specimens from 31 medical centers were sent to a centralized NGS lab for analysis between January 2018 and February 2020. Patients with IPMNs (based on KRAS and GNAS mutant status) and with available main pancreatic duct (MPD) size data were included. Patients with main-duct IPMNs and with MPD 10 mm or greater were excluded. Mixed-type IPMNs were defined as IPMNs with an MPD of 5 to 9 mm, and BD-IPMNs were defined as IPMNs with an MPD less than 5 mm. High-risk mutations (HRMs) were categorized as alterations in TP53, SMAD4, CTNNB1, and mTOR genes. Advanced neoplasia was defined as IPMNs with invasive carcinoma or high-grade dysplasia. Data were analyzed from June 1 to 5, 2025.Main Outcomes and MeasuresPrimary outcomes included rates of HRMs and the co-occurrence of 2 or more HRMs in mixed-type IPMNs and BD-IPMNs.ResultsAmong 674 patients with IPMNs, 202 had mixed-type IPMN, and 472 had BD-IPMN. There were 379 female patients (56.2%) and 295 male patients (43.8%); the mean (SD) age was 70.3 (9.6) years. HRMs were observed in 106 patients (16%), with TP53, SMAD4, and MTOR mutations more common in mixed-type IPMNs. Of the 674 patients, 167 patients underwent surgical resection, and these 167 patients had final surgical pathology available. Overall, mixed-type IPMNs had significantly higher rates of HRMs (62 [31%] vs 44 [9.3%]; P < .001) and co-occurrence of 2 or more HRMs (25 [12.4%] vs 14 [3%]; P < .001) compared with BD-IPMNs. On multivariate logistic regression, mixed-type IPMNs were independently associated with HRMs (odds ratio, 3.42; 95% CI, 1.72-6.82). Preoperative NGS detection of HRMs showed 90% sensitivity, 100% specificity, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 86% for predicting advanced neoplasia in mixed-type IPMNs. The presence of any worrisome feature or high-risk stigmata showed a sensitivity of 100%, very low specificity of 13.3%, PPV of 67%, and NPV of 100%.Conclusions and RelevanceThis study found that mixed-type IPMNs are more likely to harbor HRMs associated with advanced neoplasia. Cyst fluid NGS is highly sensitive and specific for predicting advanced neoplasia in patients with mixed-type IPMNs and should therefore be considered to help upgrade or downgrade risk based on the presence or absence of other worrisome features.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"45 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}