Intraductal papillary mucinous neoplasms of the pancreas: radiological predictors of malignant transformation and the introduction of bile duct dilation to current guidelines

Strauss, Albert; Birdsey, Matthew; Fritz, Stefan; Schwarz-Bundy, Bogata D; Bergmann, Frank; Hackert, Thilo; Kauczor, H.-U.; Grenacher, Lars; Klauß, Miriam

doi:10.1259/bjr.20150853

Cited by 15 publications

(18 citation statements)

References 25 publications

(27 reference statements)

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“…12,18 Invasive carcinoma was found in approximately 30% of surgically resected IPMNs. 19,20 The risk factors of an IPMN harboring invasive carcinoma are main-duct type, distal common bile duct dilation, size >3.0 cm, multicystic lesion, and solid component. Small, branch-duct IPMNs have a low risk of progression and are not recommended for surgical removal.…”

Section: Intraductal Papillary Mucinous Neoplasmmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma and Its Precursor Lesions

Ren

Suriawinata

2019

The American Journal of Pathology

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Pancreatic ductal adenocarcinoma is one of the most aggressive malignant neoplasms with poor outcomes. At the time of diagnosis, the disease is usually at an advanced stage and only a minority is eligible for surgical resection. To improve the prognosis, it is essential to diagnose and treat the disease in an early stage before its progression into an invasive disease. This article reviews clinical features, histopathology, cytopathology, and molecular alterations of pancreatic ductal adenocarcinoma and its precursors. Moreover, we review a recently updated two-tier classification system for precursor lesions, new findings in premalignant cystic neoplasms, and recently updated staging criteria for invasive carcinoma based on the Cancer Staging Manual, eighth edition, from the American Joint Committee on Cancer. Finally, we discuss the potential clinical applications of the rapidly growing molecular and genetic information of pancreatic cancer and its precursors. (Am J Pathol 2019, 189: 9e21; https://

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Section: Intraductal Papillary Mucinous Neoplasmmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma and Its Precursor Lesions

Ren

Suriawinata

2019

The American Journal of Pathology

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“…Mural nodule was the most frequently investigated parameter observed in 25 studies and cohort of 4495 patients [12,13,[16][17][18][19][20][21][22][23][24][25][26][30][31][32][33]35,36,38,40,42,43,46,47]. The prevalence of mural nodule in BD-IPMN was 35.8%, and the pooled malignancy rate was 31.9%.…”

Section: Mural Nodulementioning

confidence: 98%

Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis

Kwon

Han

Byun

et al. 2020

Cancers

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The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01–1.79), size ≥ 3 cm (OR 1.90, CI 1.51–2.40), cystic wall thickening (OR 2.53, CI 1.50–4.27), mural nodule (OR 4.10, CI 3.38–4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11–4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49–22.06), lymphadenopathy (OR 8.55, CI 3.25–22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55–6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60–2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.

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“…Clinical and radiologic criteria are used to assess this risk preoperatively, and approximately 30% of IPMNs that are surgically resected ultimately demonstrate invasive disease. [16][17][18][19][20] A subset of IPMNs are not recommended for surgical resection because they are at low risk of progression; these (Figure 2, a), cysts larger than 3.0 cm, numerous cysts, and the presence of a solid component or mural nodule. 8,19,21,22 The single most important factor for the surgical pathologist to evaluate in resected pancreata with IPMN is the presence or absence of an associated invasive carcinoma.…”

Section: Intraductal Papillary Mucinous Neoplasmmentioning

confidence: 99%

“…[16][17][18][19][20] A subset of IPMNs are not recommended for surgical resection because they are at low risk of progression; these (Figure 2, a), cysts larger than 3.0 cm, numerous cysts, and the presence of a solid component or mural nodule. 8,19,21,22 The single most important factor for the surgical pathologist to evaluate in resected pancreata with IPMN is the presence or absence of an associated invasive carcinoma. This starts with a careful gross evaluation for the presence or absence of mural or parenchymal masses, and extends to thorough, if not complete, sampling of the IPMN for histology.…”

Section: Intraductal Papillary Mucinous Neoplasmmentioning

confidence: 99%