A retrospective study of intraductal papillary neoplasia of the pancreas (IPMN) under surveillance

Johansson, Katarina; Kaprio, Tuomas; Nieminen, Heini; Lehtimäki, Tiina; Lantto, Eila; Haglund, Caj; Seppänen, Hanna

doi:10.1177/14574969221076792

Cited by 9 publications

(3 citation statements)

References 27 publications

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“…This is the first study to focus on the association between MMPD or ansa pancreatica with IPMN disease. The finding that MMPD occurs more frequently in IPMN patients may indicate that targeting IPMN follow-up in patients with an MMPD is helpful [31], although this warrants further investigation. An N-shape configuration may be associated with more severe IPMN disease, although our population was small.…”

Section: Discussionmentioning

confidence: 99%

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study

et al. 2022

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Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2–24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02–36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6–127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN.

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Section: Discussionmentioning

confidence: 99%

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study

et al. 2022

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“…Serum carbohydrate antigen 19-9 (CA19-9) is the only recognized biomarker for the diagnosis of pancreatic cancer [43], with a sensitivity of 79-81% and specificity of 82-90% [44]. However, CA19-9 is also increased in benign pancre-atic and biliary diseases, such as obstructive jaundice, pancreatitis, cholangitis, and cancer of the stomach, colon, ovary, uterus, liver, and other organs [45,46]. In addition, 8-10% Caucasians with Lewis A-B genotype do not express CA19-9, indicative of limitations as a biomarker of pancreatic cancer [21].…”

Section: Discussionmentioning

confidence: 99%

Differential Plasma Proteins Identified via iTRAQ-Based Analysis Serve as Diagnostic Markers of Pancreatic Ductal Adenocarcinoma

et al. 2023

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Objective. We aimed to identify differentially expressed proteins in the plasma of patients with pancreatic cancer and control subjects, which could serve as potential tumor biomarkers. Methods. Differentially expressed proteins were determined via isostatic labeling and absolute quantification (iTRAQ). Potential protein biomarkers were identified via enzyme-linked immunosorbent assay (ELISA) in 40 patients and 40 control subjects, and those eventually selected were further validated in 40 pancreatic cancer and normal pancreatic tissues. Results. In total, 30 proteins displayed significant differences in expression among which 21 were downregulated and 9 were upregulated compared with the control group. ELISA revealed downregulation of peroxiredoxin-2 (PRDX2) and upregulation of alpha-1-antitrypsin (AAT), Ras-related protein Rab-2B (RAB2B), insulin-like growth factor-binding protein 2 (IGFBP2), Rho-related GTP-binding protein RhoC (RHOC), and prelamin-A/C (LMNA) proteins in 40 other samples of pancreatic cancer. Notably, only AAT, RAB2B, and IGFBP2 levels were consistent with expression patterns obtained with iTRAQ. Moreover, all three proteins displayed a marked increase in pancreatic cancer tissues. Data from ROC curve analysis indicated that the diagnostic ability of AAT, RAB2B, and IGFBP2 combined with carbohydrate antigen 19-9 (CA19-9) for pancreatic cancer was significantly greater than that of the single indexes (area under the curve (AUC): 90% vs. 75% (CA19-9), 76% (AAT), 71% (RAB2B), and 71% (IGFBP2), all P < 0.01 ). Conclusion. AAT, RAB2B, and IGFBP2 could serve as effective biomarkers to facilitate the early diagnosis of pancreatic cancer.

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“…A study involving 377 patients with BD-IPMNs who had a median follow-up of 5.4 years found that no patients with normal CA19-9 levels developed cancer or high-grade dysplasia. Additionally, those with stable, not growing cysts of less than 15 mm and without WF or HRS may not need to undergo imaging surveillance [ 124 ]. It is well known that in pancreatic cancer, the involvement of para-aortic lymph nodes is related to a dismal prognosis.…”

Section: Prognosismentioning

confidence: 99%

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Pavlidis

Sapalidis²,

Pavlidis³

2022

Rom J Morphol Embryol

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Intraductal papillary mucinous neoplasms (IPMNs) account for approximately 35% of all cystic tumors in the pancreas and represent the largest subgroup. They are characterized by mucin production and intraductal papillary epithelium growth. IPMNs range from benign to malignant lesions. Biomarkers combined with 18F-Fluorodeoxyglucose–positron emission tomography (18FDG–PET) is the best diagnostic tool. The risk of malignant transformation for main-duct IPMNs is between 34–68% and for low-risk branch-duct (BD)-IPMNs it is 1.1%. Monitoring is crucial for determining the optimal time of surgical excision. Novel artificial intelligence combining clinical, tumor biomarkers, imaging and molecular genomics plays a determinant role in the evaluation of such lesions. The first diagnostic tool is multidetector helical computed tomography (MDHCT) or up-to-date magnetic resonance imaging (MRI). MRI detects malignancy by enhancing mural nodules ≥3 mm. Novel endosonographic interventional techniques have been added to the diagnostic armamentarium. Pancreatoscopy is feasible and effective but challenging for evaluating the diagnosis, invasiveness, and extent of IPMNs. Its findings may change the surgical approach. Pancreatic juice and duodenal fluid have been used recently for molecular biological analysis. The genes most frequently altered include Kirsten rat sarcoma viral proto-oncogene (KRAS), tumor protein p53 (TP53), cyclin-dependent kinase inhibitor 2A (CDKN2A), SMAD family member 4 (SMAD4), and guanine nucleotide-binding protein, alpha stimulating (GNAS). Despite the advances in diagnostic modalities, assessment of this premalignant lesion of pancreatic cancer, with its poor prognosis, is a challenging task. Pancreatectomy is the indicated approach for malignant or high-risk IPMNs with potent malignancy. Conservative management or enucleation for preserving the pancreas of low-risk BD-IPMNs is recommended, but long-term follow-up for recurrence is necessary. The management of IPMNs must be individualized based on preoperative high-risk stigmata and worrisome features.

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A retrospective study of intraductal papillary neoplasia of the pancreas (IPMN) under surveillance

Cited by 9 publications

References 27 publications

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study

Differential Plasma Proteins Identified via iTRAQ-Based Analysis Serve as Diagnostic Markers of Pancreatic Ductal Adenocarcinoma

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

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