Treatment Strategy for Intraductal Papillary Mucinous Neoplasm of the Pancreas Based on Malignant Predictive Factors

Hirono, Seiko

doi:10.1001/archsurg.2009.2

Cited by 55 publications

(39 citation statements)

References 20 publications

(30 reference statements)

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“…Of these studies, 33 investigated mural nodules5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 21 examined dilatation of the main pancreatic duct (MPD)7 9, 15 16, 18 21, 23 26, 27 30, 32 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 21 analysed cyst size5 7, 8, 9 14, 15 18, 20 23, 25 27, 28 31, 36 38, 40 41, 43 47, 48, 49, 17 assessed CA19‐9 increase14 …”

Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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BackgroundEstimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.MethodsA meta‐analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.ResultsA total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19‐9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.ConclusionNone of the established criteria safely distinguishes malignant from non‐malignant lesions.

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Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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“…However, the nodule's size has to be considered, because larger nodules are likely to be malignant and smaller ones are likely to be benign [20,21]. Recent studies showed that branch duct IPMNs with mural nodules of more than 5 mm included not a few benign neoplasms [17][18][19]. Therefore, in the present study, branch duct IPMNs without mural nodules or with mural nodules of less than 9 mm were followed up until nodules developed or became enlarged and reached 10 mm, when surgical resection was recommended to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies showed that resection of branch duct IPMNs that had a cyst of more than 30 mm resulted in oversurgery in many cases [6][7][8][9][10]. Although a mural nodule is a predictor of malignancy in branch duct IPMN [6,7,[11][12][13][14][15][16], nodule size has hardly been taken into consideration, with the exception of a few studies which found that branch duct IPMNs with mural nodules of more than 5 mm included not a few benign neoplasms [17][18][19]. In the present study, we followed up branch duct IPMNs without mural nodules and those with mural nodules of less than 9 mm until nodules developed or enlarged to a size of 10 mm, and we investigated whether the size of 10 mm was appropriate as an indicator of surgery for branch duct IPMN.…”

Section: Introductionmentioning

confidence: 99%

Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up

et al. 2010

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“…Despite significant advances in the diagnostic imaging technique, histopathological diagnosis of benign/malignant IPMNs is still difficult (10,23). Histological markers of the malignancy have been not enough, although several indicators for malignant potentials have been reported previously (8,14,21,22,27). It is necessary to understand the molecular features of invasion and metastasis of IPMNs in order to identify an effective therapeutic management for this histologically diverse tumor.…”

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confidence: 99%

Epithelial cell adhesion molecule (EpCAM) overexpression is correlated with malignant potentials of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas

et al. 2013

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Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas exhibit a wide range of histopathological variation. Epithelial cell adhesion molecule (EpCAM) is a 40 kDa type I membrane protein that is known to be highly expressed in epithelial carcinomas. In this study, we examined immunohistochemical expression of EpCAM in the pancreatic IPMNs in order to clarify its clinicopathological significance. We analyzed 51 cases of surgically resected IPMNs: 32 cases of adenoma; 6 cases of non-invasive carcinoma; 8 cases of minimally invasive carcinoma; and 5 cases of invasive carcinoma. Additionally, these 51 cases were classified into four phenotypes (gastric, intestinal, pancreatobiliary and oncocytic). EpCAM overexpression was found in 16 (31.4%) of the tumor samples. We found five predictive factors of malignancy using the univariate analysis as follows; serum CA19-9 level, main pancreatic duct diameter, presence of mural nodule, phenotype and EpCAM overexpression. In the multivariate analysis, only EpCAM overexpression was identified to be independently associated as a predictive factor for malignancy (odds ratio, 11.039; 95% confidence interval, 1.877-64.919; P-value, 0.008). Our study is the first report to demonstrate that EpCAM overexpression is an independent factor for malignancy; therefore, EpCAM overexpression is thought to be a novel predictor of malignant IPMNs.

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Treatment Strategy for Intraductal Papillary Mucinous Neoplasm of the Pancreas Based on Malignant Predictive Factors

Abstract: Measurement of the CEA level in pancreatic juice should be considered in the diagnosis of IPMC.

Cited by 55 publications

References 20 publications

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up

Epithelial cell adhesion molecule (EpCAM) overexpression is correlated with malignant potentials of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas

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