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Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification.
J Clin Gastroenterol 2006; 40(9):856-62JC

Abstract

GOALS

The aim of this study was to examine and clarify the preoperative markers that are useful for differentiating between benign and malignant lesions of intraductal papillary-mucinous neoplasms (IPMN) of the pancreas, grouped according to morphologic classification.

BACKGROUND

There are various stages of pathology in IPMN, ranging from benign to malignant lesions. Although the determination of appropriate treatment guidelines to deal with IPMN is a critical issue, no such guidelines have been established.

PATIENTS AND METHODS

One hundred twenty cases of IPMN were classified morphologically into either main or branch duct types. We compared the morphologic classification with histopathologic diagnosis using indicators of malignancy detected by imaging such as main duct diameter, the number and diameter of cysts, and the presence or absence of mural nodules. We also examined the usefulness of pancreatic juice cytology and measurement of telomerase activity as indicators of malignancy. Finally, we performed a survival analysis on the basis of morphologic classification to determine prognosis of IPMN.

RESULTS

Whereas a high incidence (64%) of malignant lesions was seen in main duct type IPMN, benign lesions were dominant (80.5%) in branch duct type IPMN. Survival analysis showed that the prognosis was significantly worse in main duct type than in branch duct type IPMN. The lesions were aggravated in all patients with main duct type who did not undergo resection, resulting in death due to progression of the pancreatic lesion. The incidence of mural nodules was a useful indicator in main duct type, whereas main duct diameter and incidence of mural nodules were useful indicators in branch duct type. Although pancreatic juice cytology showed a high accuracy rate with low sensitivity for determining malignancy, measurement of telomerase activity in this juice was very effective for differentiating between benign and malignant lesions.

CONCLUSIONS

The incidence of malignant lesions was extremely high in main duct type IPMN, indicating that surgery is required in all these patients. However, to determine whether surgery is indicated in branch duct type IPMN it is necessary to obtain an appropriate image diagnosis focusing on main duct diameter and mural nodules and also to carry out cytology and measurement of telomerase activity in samples of pancreatic juice.

Authors+Show Affiliations

Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biochemical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17016145

Citation

Serikawa, Masahiro, et al. "Management of Intraductal Papillary-mucinous Neoplasm of the Pancreas: Treatment Strategy Based On Morphologic Classification." Journal of Clinical Gastroenterology, vol. 40, no. 9, 2006, pp. 856-62.
Serikawa M, Sasaki T, Fujimoto Y, et al. Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. J Clin Gastroenterol. 2006;40(9):856-62.
Serikawa, M., Sasaki, T., Fujimoto, Y., Kuwahara, K., & Chayama, K. (2006). Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. Journal of Clinical Gastroenterology, 40(9), pp. 856-62.
Serikawa M, et al. Management of Intraductal Papillary-mucinous Neoplasm of the Pancreas: Treatment Strategy Based On Morphologic Classification. J Clin Gastroenterol. 2006;40(9):856-62. PubMed PMID: 17016145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. AU - Serikawa,Masahiro, AU - Sasaki,Tamito, AU - Fujimoto,Yoshifumi, AU - Kuwahara,Kenichi, AU - Chayama,Kazuaki, PY - 2006/10/4/pubmed PY - 2007/1/11/medline PY - 2006/10/4/entrez SP - 856 EP - 62 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 40 IS - 9 N2 - GOALS: The aim of this study was to examine and clarify the preoperative markers that are useful for differentiating between benign and malignant lesions of intraductal papillary-mucinous neoplasms (IPMN) of the pancreas, grouped according to morphologic classification. BACKGROUND: There are various stages of pathology in IPMN, ranging from benign to malignant lesions. Although the determination of appropriate treatment guidelines to deal with IPMN is a critical issue, no such guidelines have been established. PATIENTS AND METHODS: One hundred twenty cases of IPMN were classified morphologically into either main or branch duct types. We compared the morphologic classification with histopathologic diagnosis using indicators of malignancy detected by imaging such as main duct diameter, the number and diameter of cysts, and the presence or absence of mural nodules. We also examined the usefulness of pancreatic juice cytology and measurement of telomerase activity as indicators of malignancy. Finally, we performed a survival analysis on the basis of morphologic classification to determine prognosis of IPMN. RESULTS: Whereas a high incidence (64%) of malignant lesions was seen in main duct type IPMN, benign lesions were dominant (80.5%) in branch duct type IPMN. Survival analysis showed that the prognosis was significantly worse in main duct type than in branch duct type IPMN. The lesions were aggravated in all patients with main duct type who did not undergo resection, resulting in death due to progression of the pancreatic lesion. The incidence of mural nodules was a useful indicator in main duct type, whereas main duct diameter and incidence of mural nodules were useful indicators in branch duct type. Although pancreatic juice cytology showed a high accuracy rate with low sensitivity for determining malignancy, measurement of telomerase activity in this juice was very effective for differentiating between benign and malignant lesions. CONCLUSIONS: The incidence of malignant lesions was extremely high in main duct type IPMN, indicating that surgery is required in all these patients. However, to determine whether surgery is indicated in branch duct type IPMN it is necessary to obtain an appropriate image diagnosis focusing on main duct diameter and mural nodules and also to carry out cytology and measurement of telomerase activity in samples of pancreatic juice. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/17016145/Management_of_intraductal_papillary_mucinous_neoplasm_of_the_pancreas:_treatment_strategy_based_on_morphologic_classification_ L2 - http://Insights.ovid.com/pubmed?pmid=17016145 DB - PRIME DP - Unbound Medicine ER -