Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery
- Authors
- Kim, Tae Hyeon; Song, Tae Jun; Lee, Seung Ok; Park, Chang Hwan; Moon, Jong Ho; Pih, Gyu Young; Oh, Dong Wook; Woo, Sang Myoung; Yang, Yun Jung; Kim, Myung Hwan
- Issue Date
- Dec-2019
- Publisher
- S. Karger AG
- Keywords
- Main duct intraductal papillary mucinous neoplasms; Mixed type intraductal papillary mucinous neoplasms; Mural nodule; Pancreatic cancer
- Citation
- Pancreatology, v.19, no.8, pp 1054 - 1060
- Pages
- 7
- Journal Title
- Pancreatology
- Volume
- 19
- Number
- 8
- Start Page
- 1054
- End Page
- 1060
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/4050
- DOI
- 10.1016/j.pan.2019.09.010
- ISSN
- 1424-3903
1424-3911
- Abstract
- Objective: The guidelines for pancreatic intraductal papillary mucinous neoplasms (IPMNs) recommend surgical resection of all main-duct (MD) and mixed-type IPMNs in surgically fit patients. We conducted this study to identify the rates of high-grade dysplasia (HGD) and invasive carcinoma according to the morphological features of the main pancreatic duct (MPD) in patients with MD and mixed IPMN. Methods: We performed a retrospective study of 259 patients with histologically proven MD and mixed-type IPMNs who underwent surgery at six academic institutions. Results: The rate of HGD and invasive carcinoma was 11.1% (24/216) in patients without enhancing mural nodules (MNs) and 69.8% (30/43) in patients with MNs. Multivariate analysis showed that MPD diameter of >= 10mm [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.155-5.505; P = 0.02], diffuse MPD dilatation (OR, 3.2; 95% CI, 1.152-8.998; P = 0.02), and presence of enhancing MNs in MPD (OR, 9.6; 95% CI, 3.928-23.833, P < 0.0001) were significant predictors of HGD and invasive carcinoma. Of the 216 patients without enhancing MNs, 79 patients (36.6%) having both segmental MPD dilatation and MPD diameter of <10 mm showed significantly lower rates of HGD and invasive carcinoma (3/79, 3.8%) than patients having both diffuse MPD dilatation and MPD diameter >= 10mm (9/36, 25%, P = 0.001). Conclusions: MD and mixed-type IPMNs having segmental MPD dilatation with MPD dilation <10 mm and no enhancing MNs on imaging showed a significantly lower rate of HGD and invasive carcinoma, and watchful follow-up instead of immediate surgical resection might be possible in these patients. (C) 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.
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