Predictors of the Presence of Concomitant Invasive Ductal Carcinoma in Intraductal Papillary Mucinous Neoplasm of the Pancreas

Ingkakul, Thun; Sadakari, Yoshihiko; Ienaga, Jun; Satoh, Norihiro; Takahata, Shunichi; Tanaka, Masao

doi:10.1097/sla.0b013e3181c5ddc3

Cited by 180 publications

(85 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, there have been some retrospective studies of PC concomitant with IPMN (Table 2). 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 These studies demonstrated that the frequency of PC concomitant with IPMN ranged from 1.1% to 11.2%. As for branch duct IPMN, two working groups of JPS reported that seven PC cases were detected in 349 branch duct IPMN cases during the follow‐up period,17 and that PC concomitant with IPMN may be diagnosed earlier than ordinary PC 18.…”

Section: Risk Factors and Early Diagnosismentioning

confidence: 85%

Early diagnosis of pancreatic cancer: Current trends and concerns

Hanada

Amano

Abe

2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Early detection of pancreatic cancer (PC) is essential for a better prognosis. Some recent studies have demonstrated that a slight dilatation of the main pancreatic duct (MPD) and small cystic lesions were detected initially in most cases diagnosed at an early stage. Detecting these abnormal findings in cases with high risk factors through an effective screening system including image diagnosis, some biological markers, or familial cancer registrations should contribute to early diagnosis of PC. It has been reported that endoscopic ultrasonography (EUS) is essential for detecting tumors <10 mm with a favorable prognosis. Additionally, EUS‐guided fine‐needle aspiration biopsy is useful for confirming final histological diagnosis. For the diagnosis of stage 0 PC, local irregular stenosis of MPD should be an important initial abnormal sign detected by EUS or magnetic resonance cholangiopancreatography. Cytodiagnosis multiple times using pancreatic juice obtained by endoscopic nasopancreatic drainage should be essential for the final diagnosis. Recently, activities of regional networks between specialist doctors in medical centers and general practitioners for early diagnosis of PC have been reported in Japan. In the future, these activities may play an important role in the early diagnosis of PC.

show abstract

Section: Risk Factors and Early Diagnosismentioning

confidence: 85%

Early diagnosis of pancreatic cancer: Current trends and concerns

Hanada

Amano

Abe

2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

show abstract

“…The same authors reported 76 patients who underwent resection of BD-IPMN, of which 7 (9.2%) had concomitant noninvasive or invasive pancreatic cancer [52]. Subsequent reports of cases [53,54] and many series from Japan [55,56,57,58,59,60,61,62] indicate that concomitant pancreatic cancer occurs in 2-10% of patients with IPMN [63]. Even a small (≤1 cm diameter) BD-IPMN is associated with an 8% risk of developing distinct pancreatic cancer during surveillance [56].…”

Section: Invasive Pancreatic Cancer Concomitant With Ipmnmentioning

confidence: 99%

Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Tanaka¹

2014

Digestion

Self Cite

View full text Add to dashboard Cite

Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified as the main duct type (MD-IPMN) and the branch duct type (BD-IPMN) according to the location of involvement, and into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to the histomorphological and immunohistochemical characteristics. Mucin core protein expression correlates with the biological behavior and prognosis of the tumor. DNA analysis has shown that IPMN is associated with a number of gene mutations, but the roles of many of these mutations require further investigation. Most patients with MD-IPMN undergo tumor resection. Patients with BD-IPMN who do not undergo resection may develop malignant change, and concomitant separate pancreatic cancer occurs in 2-10% of patients with IPMN. Patients with a strong family history may develop multiple BD-IPMNs as well as concomitant pancreatic cancer. Malignant changes are relatively easy to detect, especially by endoscopic ultrasonography (EUS), but the optimal surveillance protocol is currently unclear. Key Messages: The 2012 guidelines for the management ofIPMN recommend that patients with ‘high-risk stigmata' (obstructive jaundice, enhanced solid component, and main pancreatic duct size ≥10 mm) should undergo resection. Patients with ‘worrisome features' (cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, main pancreatic duct size 5-9 mm, abrupt change in main pancreatic duct caliber with distal pancreatic atrophy, lymphadenopathy, and clinical acute pancreatitis) should be evaluated by EUS. EUS is a more sensitive test than computed tomography or magnetic resonance imaging for the early detection of malignancy. Conclusions: Most patients with MD-IPMN should undergo tumor resection. Patients with BD-IPMN who do not undergo resection should undergo careful surveillance including EUS for the early detection of malignant change and separate pancreatic cancer.

show abstract

“…These figures are perplexing, especially if we keep in mind that some 10% of individuals older than 70 years have a sub-centimeter pancreatic cyst. Our own experience and reports by other groups lead us to believe that this seemingly high prevalence of HGD and invasive carcinoma arising from very small BD-IPMN could be explained by the presence of a small IPMN with LGD adjacent to a concomitant conventional PDAC, as the distinction between the two events is often challenging [10,74,75].…”

Section: Iap and Aga Guidelines: How We Use Themmentioning

confidence: 99%

“…There is no conclusive evidence that multifocal IPMN pose a higher risk of HGD or invasive carcinoma, and we thus recommend that each cyst be assessed individually, rather than performing a total pancreatectomy upfront [10,48,72]. More critically, concomitant PDAC may develop in 3-11% of patients, either in the primary resection specimen or as a metachronous event [73][74][75]. While our experience suggests that metachronous PDAC after resection for IPMN is uncommon (0.5%), other series have reported a 5-and 10-year cumulative incidence of 4.5 and 5.9%, respectively [76].…”

Section: Follow-up Of Resected Patients: Predicting Recurrent and Newmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

et al. 2017

View full text Add to dashboard Cite

Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed. The approach to IPMN must therefore strike a balance between preventing the over-utilization of surgery and the timely recognition and treatment of patients with high-risk lesions. Several clinical, radiographic, and laboratory parameters have been proposed to risk-stratify IPMN, leading to the publication of management guidelines that do not always converge in their recommendations. The goal of this clinical therapeutic review is to describe the strategic approach to IPMN at the Massachusetts General Hospital, and how our current understanding, management algorithm, and future directions have been informed by research efforts at our institution and other centers.

show abstract

Predictors of the Presence of Concomitant Invasive Ductal Carcinoma in Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract: In view of the high prevalence of DC careful inspection of the entire pancreatic gland is necessary for early detection of DC in patients with branch duct IPMNs, especially when worsening diabetes mellitus and an abnormal serum CA 19-9 level are manifested.

Cited by 180 publications

References 26 publications

Early diagnosis of pancreatic cancer: Current trends and concerns

Early diagnosis of pancreatic cancer: Current trends and concerns

Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

Contact Info

Product

Resources

About