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Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms.
Arch Surg. 2003 Jun; 138(6):610-7; discussion 617-8.AS

Abstract

HYPOTHESIS

Malignant intraductal papillary mucinous neoplasms (IPMNs) can be predicted before surgery.

DESIGN

Retrospective review of a prospectively collected database.

SETTING

Academic, urban, tertiary care hospital.

PATIENTS

Sixty-four consecutive patients with a pathological diagnosis of IPMN.

INTERVENTIONS

All 64 patients underwent surgical intervention for IPMN between December 8, 1988, and October 16, 2002.

MAIN OUTCOME MEASURES

Reliable predictors of malignancy.

RESULTS

The 64 patients underwent 69 operations: 39 pancreaticoduodenectomies, 18 distal pancreatectomies, 7 total pancreatectomies, 4 neck and/or body pancreatectomies, and 1 cystgastrostomy with pancreatic biopsy. Twenty-three of 69 specimens were malignant-12 in situ (high-grade dysplasia) and 11 invasive. In a univariate analysis of 12 clinical signs or symptoms recorded, diabetes mellitus and jaundice showed a significant association with malignancy of IPMN. Of 24 serum chemistry studies, hematologic studies, and tumor marker analyses (in serum, bile, and pancreatic fluid), elevation of serum alkaline phosphatase and glucose levels showed correlation with malignancy. Computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography findings did not distinguish between benign and malignant tumors. Atypia on preoperative cytologic analysis was specific for malignancy (93%) but lacked the same degree of sensitivity (40% in situ, 91% invasive, and 67% overall).

CONCLUSIONS

Malignancy of IPMNs is suggested by new-onset diabetes mellitus, jaundice, and elevations in serum glucose or alkaline phosphatase levels. Atypia on preoperative cytologic testing is the finding most predictive of malignancy. The absence of these features does not predict benign disease. These findings may help guide patient and physician decision making.

Authors+Show Affiliations

Department of Surgery, Indiana University School of Medicine, USA. maxschmi@iupui.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12799331

Citation

Wiesenauer, Chad A., et al. "Preoperative Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms." Archives of Surgery (Chicago, Ill. : 1960), vol. 138, no. 6, 2003, pp. 610-7; discussion 617-8.
Wiesenauer CA, Schmidt CM, Cummings OW, et al. Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms. Arch Surg. 2003;138(6):610-7; discussion 617-8.
Wiesenauer, C. A., Schmidt, C. M., Cummings, O. W., Yiannoutsos, C. T., Howard, T. J., Wiebke, E. A., Goulet, R. J., McHenry, L., Sherman, S., Lehman, G. A., Cramer, H., & Madura, J. A. (2003). Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms. Archives of Surgery (Chicago, Ill. : 1960), 138(6), 610-7; discussion 617-8.
Wiesenauer CA, et al. Preoperative Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms. Arch Surg. 2003;138(6):610-7; discussion 617-8. PubMed PMID: 12799331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms. AU - Wiesenauer,Chad A, AU - Schmidt,C Max, AU - Cummings,Oscar W, AU - Yiannoutsos,Constantin T, AU - Howard,Thomas J, AU - Wiebke,Eric A, AU - Goulet,Robert J,Jr AU - McHenry,Lee, AU - Sherman,Stuart, AU - Lehman,Glen A, AU - Cramer,Harvey, AU - Madura,James A, PY - 2003/6/12/pubmed PY - 2003/7/9/medline PY - 2003/6/12/entrez SP - 610-7; discussion 617-8 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 138 IS - 6 N2 - HYPOTHESIS: Malignant intraductal papillary mucinous neoplasms (IPMNs) can be predicted before surgery. DESIGN: Retrospective review of a prospectively collected database. SETTING: Academic, urban, tertiary care hospital. PATIENTS: Sixty-four consecutive patients with a pathological diagnosis of IPMN. INTERVENTIONS: All 64 patients underwent surgical intervention for IPMN between December 8, 1988, and October 16, 2002. MAIN OUTCOME MEASURES: Reliable predictors of malignancy. RESULTS: The 64 patients underwent 69 operations: 39 pancreaticoduodenectomies, 18 distal pancreatectomies, 7 total pancreatectomies, 4 neck and/or body pancreatectomies, and 1 cystgastrostomy with pancreatic biopsy. Twenty-three of 69 specimens were malignant-12 in situ (high-grade dysplasia) and 11 invasive. In a univariate analysis of 12 clinical signs or symptoms recorded, diabetes mellitus and jaundice showed a significant association with malignancy of IPMN. Of 24 serum chemistry studies, hematologic studies, and tumor marker analyses (in serum, bile, and pancreatic fluid), elevation of serum alkaline phosphatase and glucose levels showed correlation with malignancy. Computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography findings did not distinguish between benign and malignant tumors. Atypia on preoperative cytologic analysis was specific for malignancy (93%) but lacked the same degree of sensitivity (40% in situ, 91% invasive, and 67% overall). CONCLUSIONS: Malignancy of IPMNs is suggested by new-onset diabetes mellitus, jaundice, and elevations in serum glucose or alkaline phosphatase levels. Atypia on preoperative cytologic testing is the finding most predictive of malignancy. The absence of these features does not predict benign disease. These findings may help guide patient and physician decision making. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/12799331/Preoperative_predictors_of_malignancy_in_pancreatic_intraductal_papillary_mucinous_neoplasms_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/vol/138/pg/610 DB - PRIME DP - Unbound Medicine ER -