Preoperative evaluation of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas: clinical, radiological, and pathological analysis of 123 cases.

Abstract:

OBJECTIVE:We aimed to investigate preoperative findings that are useful to distinguish intraductal papillary-mucinous neoplasm (IPMN) subtypes. METHODS:One hundred twenty-three patients who underwent pancreatectomy for IPMN were analyzed clinicopathologically and radiologically. Invasive IPM carcinomas (IPMCs) were subdivided into early-stage nonaggressive (minimally invasive IPMC [MI-IPMC]) and more advanced and aggressive (invasive carcinoma originating in IPMC [IC-IPMC]) subtypes according to our recently proposed pathological criteria. RESULTS:The lesions consisted of 27 IPMNs with low-grade dysplasia, 14 IPMNs with moderate dysplasia, 21 IPMNs with high-grade dysplasia, 30 MI-IPMCs, and 31 IC-IPMCs. Multidetector-row computed tomography detected a component of invasive carcinoma in IC-IPMC with 86% sensitivity and 100% specificity. In patients with IPMNs other than IC-IPMC, multivariate analysis demonstrated 3 significant predictive factors of malignancy: IPMN size (>40 mm), IPMN duct type (main pancreatic duct or mixed type), and the presence of a mural nodule or thick septum. The diagnostic score obtained using these 3 factors showed a strong correlation with the presence of malignancy. CONCLUSIONS:For preoperative evaluation of patients with IPMN, it is recommended to rule out IC-IPMC using multidetector-row computed tomography and then to categorize IPMN other than IC-IPMC according to malignant potential based on the diagnostic score.

journal_name

Pancreas

journal_title

Pancreas

authors

Nara S,Onaya H,Hiraoka N,Shimada K,Sano T,Sakamoto Y,Esaki M,Kosuge T

doi

10.1097/MPA.0b013e318181b90d

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

8-16

issue

1

eissn

0885-3177

issn

1536-4828

journal_volume

38

pub_type

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