Pre-operative nomogram predicting malignant potential in the patients with intraductal papillary mucinous neoplasm of the pancreas: focused on imaging features based on revised international guideline

Hwang, Jeong Ah; Choi, Sung Yong; Lee, Ji Eun; Kim, Seung Soo; Lee, Sun Young; Moon, Ji Yoon; Heo, Nam Hun

doi:10.1007/s00330-020-06736-6

Cited by 16 publications

(16 citation statements)

References 36 publications

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“…The occurrence of PA in IPMNs is not uncommon. Two recent radiological studies showed that 23% of IPMN patients had PA in computed tomography (CT) images (16,17), which was similar to the occurrence of the MPD size ≥1.0 cm. Our data showed that 18.2% of IPMN patients had PA that was consistent with those previous results.…”

Section: Discussionmentioning

confidence: 76%

“…Several guidelines have showed malignant features or surgical indications for IPMNs (2), such as MN or enhanced solid component, MPD > 1.0 cm, and tumor size ≥ 3.0 cm. The diagnostic performances of the 2017 revised International Consensus Guidelines have been validated by some studies (16,17,28). Lee et al (16) indicated that the diagnostic performance of CT and MRI (based on high-risk stigmata and worrisome features) were both good, AUC = 0.83 for CT and AUC = 0.86 for MRI.…”

Section: Discussionmentioning

confidence: 99%

“…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). By contrast, some studies did not observe such association in univariate or multivariate analysis (21)(22)(23)(24)(25)(26).…”

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: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Characteristics of articles included for qualitative and quantitative analysis are listed in Table 1 and Table 2 . From the 20 included articles [ 12 , 14 , 15 , 17 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 44 , 45 ], a total of 3982 resected IPMN cases (including BD-IPMN, MD-IPMN, or mixed-type IPMN) were collected. Of the 3982 resected cases, 1516 and 2466 were malignant and non-malignant cases, respectively.…”

Section: Resultsmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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Intraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study tests the diagnostic value of the main pancreatic duct (MPD) diameter for detecting IPMN malignancy using a meta-analysis of published data of resected IPMNs. Collected from a comprehensive literature search, the articles included in this analysis must report malignancy cases (high-grade dysplasia (HGD) and invasive carcinoma (IC)) and MPD diameter so that two MPD cut-offs could be created. The sensitivity, specificity, and odds ratios of the two cutoffs for predicting malignancy were calculated. A review of 1493 articles yielded 20 retrospective studies with 3982 resected cases. A cutoff of ≥5 mm is more sensitive than the ≥10 mm cutoff and has pooled sensitivity of 72.20% and 75.60% for classification of HGD and IC, respectively. Both MPD cutoffs of ≥5 mm and ≥10 mm were associated with malignancy (OR = 4.36 (95% CI: 2.82, 6.75) vs. OR = 3.18 (95% CI: 2.25, 4.49), respectively). The odds of HGD and IC for patients with MPD ≥5 mm were 5.66 (95% CI: 3.02, 10.62) and 7.40 (95% CI: 4.95, 11.06), respectively. OR of HGD and IC for MPD ≥10 mm cutoff were 4.36 (95% CI: 3.20, 5.93) and 4.75 (95% CI: 2.39, 9.45), respectively. IPMN with MPD of >5 mm could very likely be malignant. In selected IPMN patients, pancreatectomy should be considered when MPD is >5 mm.

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“…IPMN has a well-defined illness concept, and the risk of malignant transformation has been revealed in several studies [3][4][5]. Additionally, the indications for surgical resection are well established, with the findings of its natural history [6,7]. Preinvasive tumor therapy can be performed to improve the prognosis of patients with pancreatic disease.…”

Section: Introductionmentioning

confidence: 99%

Natural history of intracholecystic papillary neoplasm (ICPN): a rare case of ICPN whose natural history was closely followed by ultrasound

et al. 2022

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The natural history of intracholecystic papillary neoplasm (ICPN), especially the speed of growth from small benign to a carcinomatous lesion, is quite unrevealed. Here, we report an extremely rare case of ICPN, in which the papillary lesion was observed transforming from small and benign to malignant using abdominal ultrasound (AUS) over 2 years during routine health checks. A 44-year-old man underwent a routine health check-up. The initial AUS showed a small sessile polyp in the gallbladder, which enlarged slightly at the next AUS, a year later. In the third year, the polypoid lesion enlarged markedly, with a maximum diameter of 10 × 9 × 7 mm. Therefore, a laparoscopic cholecystectomy was performed. Microscopically, the 10 mm tumor had intracytoplasmic mucus, and a clear cytoplasm compatible with gastric-type features. Immunohistochemical analysis showed positive staining of atypical cells for MUC6 and PAS. These findings led to the diagnosis of ICPN with high-grade intraepithelial neoplasia of the gastric type. In conclusion, sessile polyps with rapid growth might be a crucial finding in the early stage of ICPN.

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Pre-operative nomogram predicting malignant potential in the patients with intraductal papillary mucinous neoplasm of the pancreas: focused on imaging features based on revised international guideline

Cited by 16 publications

References 36 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

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Natural history of intracholecystic papillary neoplasm (ICPN): a rare case of ICPN whose natural history was closely followed by ultrasound

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