Intraductal Papillary Mucinous Neoplasm of the Pancreas: Can Benign Lesions Be Differentiated from Malignant Lesions with Multidetector CT?

Kawamoto, Satomi; Horton, Karen M.; Lawler, Leo P.; Hruban, Ralph H.; Fishman, Elliot K.

doi:10.1148/rg.256055036

Cited by 90 publications

(51 citation statements)

References 39 publications

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“…14, 15 The presence of calcification within the tumour was evaluated on non-enhanced CT. We considered intratumoural calcification when high attenuating foci in the tumour (visually opaque as bone or .200 HU) was noted.…”

Section: 12mentioning

confidence: 99%

DPC4 gene expression in primary pancreatic ductal adenocarcinoma: relationship with CT characteristics

Choi

Kim

et al. 2017

BJR

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Objective: To investigate the relationship between CT imaging findings and DPC4 gene expression and to determine the prognostic value of DPC4 gene expression to predict overall survival in patients with pancreatic ductal adenocarcinoma. Methods: Between January and December 2011, we retrospectively analyzed 163 pancreatic ductal adenocarcinomas in 163 patients who had undergone surgical resection (mean age 5 61.8 years; range 5 35-81 years). We divided the study patients into two groups according to DPC4 gene expression: DPC4-expression or DPC4-non-expression group. The CT findings were analyzed by two reviewers. The associations between the CT imaging findings and DPC4 gene expression were evaluated using univariate analysis and multivariate logistic regression analysis. Overall survival was compared according to the DPC4 gene expression (DPC4-expression vs DPC4-nonexpression) using Kaplan-Meier analysis and log-rank testing. To avoid bias, subgroup analyses of CT findings in T3 tumour and overall survival in patients with T3 tumour and R0 resection were performed. Results: Between DPC4-expression group (n 5 75) and DPC4-non-expression group (n 5 88), three CT findings (i.e., tumour margin, peripancreatic infiltration, and the presence of background intraductal pancreatic mucinous neoplasm) were significantly different in univariate analysis. Of these, a well-defined tumour margin was significantly associated with DPC4-expression tumour (adjusted odds ratio 5 2.06; p 5 0.032) in multivariate analysis. Of the total 163 patients, the mean overall survival of the DPC4-expression group was significantly longer than that of the DPC4-non-expression group (30.0 vs 22.0 months; p 5 0.049). Of the 150 T3 tumours, the presence of well-defined tumour margins was also a significant CT finding (adjusted odd ratio 5 2.00; p 5 0.044) in multivariate analysis. However, of 131 patients with T3 tumour and R0 resection, the overall survival period of the DPC4-expression group was not significantly different from that of the DPC4-nonexpression group (24.0 vs 22.0 months; p 5 0.240). Conclusion: The presence of well-defined tumour margins on CT was significantly linked with DPC4-expression tumour. Advances in knowledge: A well-defined tumour margin is an independent CT finding associated with DPC4-expression pancreatic ductal adenocarcinoma.

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Section: 12mentioning

confidence: 99%

DPC4 gene expression in primary pancreatic ductal adenocarcinoma: relationship with CT characteristics

Choi

Kim

et al. 2017

BJR

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“…The primary advantage of cross-sectional imaging such as CT scan and magnetic resonance (MR) of pancreatic cystic lesions over endoscopic techniques lies in determining the extent of malignant spread (39,40). Features predictive of invasive carcinoma in IPMN by CT and other imaging studies include involvement of the main pancreatic duct, marked dilatation of the main pancreatic duct, diffuse or multifocal involvement, the presence of a large mural nodule or solid mass, large size of the mass, and obstruction of the common bile duct.…”

Section: Imaging (Level 2-3)mentioning

confidence: 99%

“…Features predictive of invasive carcinoma in IPMN by CT and other imaging studies include involvement of the main pancreatic duct, marked dilatation of the main pancreatic duct, diffuse or multifocal involvement, the presence of a large mural nodule or solid mass, large size of the mass, and obstruction of the common bile duct. The presence of intracystic mural nodules >3 mm in size on CT also suggests malignancy (39)(40)(41). MRP is more sensitive than ERCP in differentiating mural nodules from mucin globules (40)(41)(42)(43)(44).…”

Section: Imaging (Level 2-3)mentioning

confidence: 99%

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

Khalid¹,

Brugge²

2007

Am J Gastroenterology

290

197

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The diagnosis and management of pancreatic cystic lesions is a common problem. At least 1% of hospitalized patients at major medical centers will have a pancreatic cystic lesion on cross sectional imaging. Up to a quarter of all pancreata examined in an autopsy series contained a pancreatic cyst, 16% of which were lined by an "atypical" epithelium and 3% of which had progressed to carcinoma-in-situ (high grade dysplasia). in the past, it was thought these cystic lesions were benign, but increasing evidence points to the cystic lesions as being the origin of some pancreatic malignancies.The most important clinical tools in the diagnosis and management of pancreatic cystic lesions are cross sectional imaging, endoscopic ultrasound, and cyst fluid analysis. The most important differential diagnosis is distinguishing mucinous (pre-malignant) and non-mucinous cystic lesions. The findings of a macrocystic lesion containing viscous fluid rich in CEA are supportive of a diagnosis of a mucinous lesion. Serous lesion are the most common non-mucinous cyst and are characterized by a microcystic morphology, non-viscous fluid and a low concentration of CEA in the cyst fluid.The following document includes a description of neoplastic pancreatic cysts, a critical review of relevant diagnostic tests, and a discussion of treatment options. We have proposed a set of guidelines for the diagnonis and management of patients with neoplastic pancreatic cysts. The guidelines are based on published data backed by an analysis of the quality of the data and are designed to address the most frequent and important clinical scenarios. In addition to providing a summary of the diagnostic data, we offer diagnostic and management suggestions based on 13 common clinical problems. Although the field is rapidly evolving, a set of core principles is provided based on a balance between the risk of malignancy and the benefit of pancreatic resection.

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“…In MD IPMNs, ERCP shows dilated ducts and a filling defect caused by mucin or the cysts themselves, while in BD IPMNs the involved branches show dilation and communicate with the main duct (Lim et al, 2001). It has been reported that ERCP showed the communication of the cystic lesion with the pancreatic duct in 80.8% of the cases while MRCP showed 55.7%, CT showed 53.8%, and MRI showed 42.3% (Kawamoto et al, 2005). Another advantage of ERCP is that cytological sampling can be required, though it is an invasive procedure.…”

Section: Endoscopic Retrograde Cholangiopancreatography (Ercp)mentioning

confidence: 99%

Pancreatic cystic neoplasms: a review of preoperative diagnosis and management

Bai

Zhang

Masood

et al. 2013

J. Zhejiang Univ. Sci. B

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Pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

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Intraductal Papillary Mucinous Neoplasm of the Pancreas: Can Benign Lesions Be Differentiated from Malignant Lesions with Multidetector CT?

Cited by 90 publications

References 39 publications

DPC4 gene expression in primary pancreatic ductal adenocarcinoma: relationship with CT characteristics

DPC4 gene expression in primary pancreatic ductal adenocarcinoma: relationship with CT characteristics

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

Pancreatic cystic neoplasms: a review of preoperative diagnosis and management

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