Distinct patterns of peritumoral histological findings in subtypes of intraductal papillary mucinous neoplasms of the pancreas

Saito, Masanori; Imada, Hiroki; Suzuki, Takahiro; Sata, Naohiro; Yasuda, Yoshikazu; Maetani, Iruru; Fukushima, Noriyoshi

doi:10.1016/j.anndiagpath.2015.07.005

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…First, only the patients who underwent surgery and MRI examinations were included, which may cause selection bias. The generalization of our results should be confirmed by other studies, even though pathological studies have shown that PA was related to invasive carcinoma or malignant IPMNs (8,11). Second, PA was evaluated by radiological examinations, not by pathological examinations.…”

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

“…Interestingly, some studies have found that pathological PA was also related to invasive carcinoma or malignant IPMNs (8)(9)(10)(11). Saito et al (8) found that PA and fibrosis were more common in a high grade of IPMNs than that in a low grade (50%-76% vs. 6%). In addition, several studies showed that abrupt MPD caliber change with distal PA reported during radiological examinations was associated with malignant IPMNs or invasive carcinoma in all IPMNs and branch-duct IPMNs (BD-IPMNs) (12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

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MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm

Lin

Chen²,

Liu³

et al. 2022

Front. Oncol.

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BackgroundAbrupt change in the caliber of the main pancreatic duct (MPD) with distal pancreatic atrophy (PA) was considered as one of worrisome features in the International Association of Pancreatology guideline and American College of Gastroenterology guideline for the management of intraductal papillary mucinous neoplasms (IPMNs). However, this feature was not included in other guidelines. Moreover, the association between PA alone and malignancy in IPMNs has not been fully evaluated. In the present study, we investigated the role of image-based PA in identifying malignant IPMNs or invasive carcinoma.MethodsA total of 186 patients with IPMNs were included for analysis. The tumor size, location, MPD diameter, presence of a mural nodule (MN), and PA were evaluated using magnetic resonance imaging. Demographic information and serum carbohydrate antigen 19-9 and carcinoembryonic antigen (CEA) levels were also collected. IPMNs with high-grade dysplasia and associated invasive carcinoma were regarded as malignant IPMNs.ResultsPA was observed in 34 cases (18.3%). The occurrence of malignant IPMNs or invasive carcinoma in patients with PA were significantly higher than in those without PA (52.9% vs. 22.3%; 44.1% vs. 8.9%, all P < 0.01). Multivariate logistic regression analysis showed that PA was an independently associated factor for malignant IPMNs [odds ratio (OR) = 2.69, 95% confidence interval (CI): 1.07-6.78] or invasive carcinoma (OR = 7.78, 95%CI: 2.62-23.10) after modified with confounders. Subgroup analysis in MPD-involved IPMNs also indicated that PA was an independently associated factor for invasive carcinoma (OR = 9.72, 95%CI: 2.43-38.88). PA had a similar performance with MPD plus MN [the area under the curve (AUC) was both 0.71] in identifying malignancy. PA had a higher performance in identifying invasive carcinoma in MPD-involved IPMNs than MN (AUC = 0.71 vs. 0.65, P = 0.02).ConclusionOur data showed that imaging-based PA was associated with malignancy or invasive carcinoma regardless of abrupt change in the caliber of MPD in IPMNs. PA had an acceptable performance in identifying malignant IPMNs.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm

Lin

Chen²,

Liu³

et al. 2022

Front. Oncol.

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“…The features of the main pancreatic duct might suggest tumor spread into remnant pancreatic parenchyma as in the second mechanism. In general, most studies did not report any significant difference in the risk of obstructive pancreatitis between benign and malignant IPMNs [ 21 – 23 ] because mucous embolism of the main pancreatic duct is more frequent in intestinal type with a better prognosis [ 24 , 25 ]. In addition, the maximum diameter of the main pancreatic duct was correlated with the distance of tumor spread in the main pancreatic duct [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Optimal surveillance of intraductal papillary mucinous neoplasms of the pancreas focusing on remnant pancreas recurrence after surgical resection

et al. 2022

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Background The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence, including de novo lesions, is essential, optimal surveillance protocols have not been established. Aim and methods This study aimed to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one patients of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence. Results The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n = 42), high-grade dysplasia (HAD, n = 19), and invasive carcinoma (IPMC, n = 30). Recurrence was observed in 26 patients (29%), of which recurrence was seen at Rem-Panc in 19 patients (21%) and Ex-Panc in 7 patients (8%). The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs. 35 months, p < 0.001; median OS 25 months vs. 72 months, p < 0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no repeat pancreatectomy (MST 36 months vs. 15.5 months, p = 0.033). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p = 0.002) and positive surgical margin (HR 4.4, p = 0.018) were identified as risk factors for Rem-Panc recurrence. Conclusions The risk factors for Rem-Panc and Ex-Panc recurrence differ. Therefore, optimal surveillance on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.

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“…because mucous embolism of the main pancreatic duct is more frequent in intestinal type with a better prognosis [24,25]. In addition, the maximum diameter of the main pancreatic duct was correlated with the distance of tumor spread in the main pancreatic duct [26].…”

Section: Discussionmentioning

confidence: 99%

Optimal Surveillance of Intraductal Papillary Mucinous Neoplasms of the Pancreas Focusing on Remnant Pancreas Recurrence After Surgical Resection

Fuji

Umeda

Takagi

et al. 2021

Preprint

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Background: The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence including de novo lesions is essential, optimal surveillance protocols have not been established.Aim and Methods: The aim of this study was to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one cases of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence.Results: The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n=42), high-grade dysplasia (HAD, n=19), and invasive carcinoma (IPMC, n=30). Recurrence was observed in 26 cases (28%), of which recurrence was seen at Rem-Panc in 19 cases and at Ex-Panc in 7 cases. The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs 35 months, p<0.001; median OS 25 months vs 72 months, p<0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no-pancreatectomy (MST 36 months vs 15.5 months, p=0.03). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p=0.002) and positive surgical margin (HR 4.4, p=0.018) were identified as risk factors for Rem-Panc recurrence.Conclusions: The risk factors for Rem-Panc and Ex-Panc recurrence differ. Optimal surveillance based on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.

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Distinct patterns of peritumoral histological findings in subtypes of intraductal papillary mucinous neoplasms of the pancreas

Cited by 9 publications

References 18 publications

MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm

MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm

Optimal surveillance of intraductal papillary mucinous neoplasms of the pancreas focusing on remnant pancreas recurrence after surgical resection

Optimal Surveillance of Intraductal Papillary Mucinous Neoplasms of the Pancreas Focusing on Remnant Pancreas Recurrence After Surgical Resection

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