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Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery.
Pancreatology. 2019 Dec; 19(8):1054-1060.P

Abstract

OBJECTIVE

The guidelines for pancreatic intraductal papillary mucinous neoplasms (IPMNs) recommend surgical resection of all main-duct (MD) and mixed-type IPMNs in surgically fit patients. We conducted this study to identify the rates of high-grade dysplasia (HGD) and invasive carcinoma according to the morphological features of the main pancreatic duct (MPD) in patients with MD and mixed IPMN.

METHODS

We performed a retrospective study of 259 patients with histologically proven MD and mixed-type IPMNs who underwent surgery at six academic institutions.

RESULTS

The rate of HGD and invasive carcinoma was 11.1% (24/216) in patients without enhancing mural nodules (MNs) and 69.8% (30/43) in patients with MNs. Multivariate analysis showed that MPD diameter of ≥10 mm [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.155-5.505; P = 0.02], diffuse MPD dilatation (OR, 3.2; 95% CI, 1.152-8.998; P = 0.02), and presence of enhancing MNs in MPD (OR, 9.6; 95% CI, 3.928-23.833, P < 0.0001) were significant predictors of HGD and invasive carcinoma. Of the 216 patients without enhancing MNs, 79 patients (36.6%) having both segmental MPD dilatation and MPD diameter of <10 mm showed significantly lower rates of HGD and invasive carcinoma (3/79, 3.8%) than patients having both diffuse MPD dilatation and MPD diameter ≥10 mm (9/36, 25%, P = 0.001).

CONCLUSIONS

MD and mixed-type IPMNs having segmental MPD dilatation with MPD dilation <10 mm and no enhancing MNs on imaging showed a significantly lower rate of HGD and invasive carcinoma, and watchful follow-up instead of immediate surgical resection might be possible in these patients.

Authors+Show Affiliations

Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, South Korea.Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Chonbuk National University Medical School, Jeonju, South Korea.Department of Internal Medicine, Chonnam University College of Medicine, Kwangju, South Korea.Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, South Korea.Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Pancreatobiliary Cancer Clinic, Center for Liver Cancer, National Cancer Center, Goyang, South Korea.Institute for Integrative Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea.Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: mhkim@amc.seoul.kr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31611130

Citation

Kim, Tae Hyeon, et al. "Main Duct and Mixed Type Intraductal Papillary Mucinous Neoplasms Without Enhancing Mural Nodules: Duct Diameter of Less Than 10 Mm and Segmental Dilatation of Main Pancreatic Duct Are Findings Support Surveillance Rather Than Immediate Surgery." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 19, no. 8, 2019, pp. 1054-1060.
Kim TH, Song TJ, Lee SO, et al. Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery. Pancreatology. 2019;19(8):1054-1060.
Kim, T. H., Song, T. J., Lee, S. O., Park, C. H., Moon, J. H., Pih, G. Y., Oh, D. W., Woo, S. M., Yang, Y. J., & Kim, M. H. (2019). Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 19(8), 1054-1060. https://doi.org/10.1016/j.pan.2019.09.010
Kim TH, et al. Main Duct and Mixed Type Intraductal Papillary Mucinous Neoplasms Without Enhancing Mural Nodules: Duct Diameter of Less Than 10 Mm and Segmental Dilatation of Main Pancreatic Duct Are Findings Support Surveillance Rather Than Immediate Surgery. Pancreatology. 2019;19(8):1054-1060. PubMed PMID: 31611130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery. AU - Kim,Tae Hyeon, AU - Song,Tae Jun, AU - Lee,Seung Ok, AU - Park,Chang Hwan, AU - Moon,Jong Ho, AU - Pih,Gyu Young, AU - Oh,Dong Wook, AU - Woo,Sang Myoung, AU - Yang,Yun Jung, AU - Kim,Myung Hwan, Y1 - 2019/09/24/ PY - 2019/05/06/received PY - 2019/09/14/revised PY - 2019/09/22/accepted PY - 2019/10/16/pubmed PY - 2020/5/16/medline PY - 2019/10/16/entrez KW - Main duct intraductal papillary mucinous neoplasms KW - Mixed type intraductal papillary mucinous neoplasms KW - Mural nodule KW - Pancreatic cancer SP - 1054 EP - 1060 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 19 IS - 8 N2 - OBJECTIVE: The guidelines for pancreatic intraductal papillary mucinous neoplasms (IPMNs) recommend surgical resection of all main-duct (MD) and mixed-type IPMNs in surgically fit patients. We conducted this study to identify the rates of high-grade dysplasia (HGD) and invasive carcinoma according to the morphological features of the main pancreatic duct (MPD) in patients with MD and mixed IPMN. METHODS: We performed a retrospective study of 259 patients with histologically proven MD and mixed-type IPMNs who underwent surgery at six academic institutions. RESULTS: The rate of HGD and invasive carcinoma was 11.1% (24/216) in patients without enhancing mural nodules (MNs) and 69.8% (30/43) in patients with MNs. Multivariate analysis showed that MPD diameter of ≥10 mm [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.155-5.505; P = 0.02], diffuse MPD dilatation (OR, 3.2; 95% CI, 1.152-8.998; P = 0.02), and presence of enhancing MNs in MPD (OR, 9.6; 95% CI, 3.928-23.833, P < 0.0001) were significant predictors of HGD and invasive carcinoma. Of the 216 patients without enhancing MNs, 79 patients (36.6%) having both segmental MPD dilatation and MPD diameter of <10 mm showed significantly lower rates of HGD and invasive carcinoma (3/79, 3.8%) than patients having both diffuse MPD dilatation and MPD diameter ≥10 mm (9/36, 25%, P = 0.001). CONCLUSIONS: MD and mixed-type IPMNs having segmental MPD dilatation with MPD dilation <10 mm and no enhancing MNs on imaging showed a significantly lower rate of HGD and invasive carcinoma, and watchful follow-up instead of immediate surgical resection might be possible in these patients. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/31611130/Main_duct_and_mixed_type_intraductal_papillary_mucinous_neoplasms_without_enhancing_mural_nodules:_Duct_diameter_of_less_than_10_mm_and_segmental_dilatation_of_main_pancreatic_duct_are_findings_support_surveillance_rather_than_immediate_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(19)30731-8 DB - PRIME DP - Unbound Medicine ER -