Significance of Uncinate Duct Dilatation in IPMNs: A New High-risk Criterion?
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
18
11
2020
medline:
1
6
2022
entrez:
17
11
2020
Statut:
ppublish
Résumé
To evaluate the significance of UDD in IPMNs. The uncinate process of the pancreas has an independent ductal drainage system. International consensus guidelines of IPMNs still consider it as a branch-duct, even though it is the main drainage system for the uncinate process. A retrospective review of all surgically treated IPMNs at our institution after 2008 was performed. Preoperative radiological studies were reviewed by an abdominal radiologist who was blinded to the pathological results. In addition to the Fukuoka criteria, presence of UDD was recorded. Using multivariate analysis, the pathological significance of UDD in predicting advanced neoplasia [high grade dysplasia or invasive carcinoma (HGD/ IC)] was determined. Two hundred sixty patients were identified (mean age at diagnosis was 68 years and 49% were females): 122 (47%) had HGD/IC. UDD was noted in 59 (23%), of which 36 (61%) had HGD/IC (P < 0.003). On multivariate analysis, UDD was an independent predictor of HGD/IC (odds ratio = 2.99, P < 0.04). Subgroup analysis on patients with IPMNs confined to the dorsal portion of the gland (n = 161), also demonstrated UDD to be a significant predictor of HGD/IC in those remote lesions (odds ratio: 4.41, P = 0.039). This is the largest study to evaluate the significance of UDD in IPMNs and shows it to be a high-risk feature. This association persisted for remote IPMNs limited to the dorsal pancreas, suggesting UDD may be associated with an aggressive phenotype even in remote IPMN lesions.
Sections du résumé
OBJECTIVE
To evaluate the significance of UDD in IPMNs.
BACKGROUND
The uncinate process of the pancreas has an independent ductal drainage system. International consensus guidelines of IPMNs still consider it as a branch-duct, even though it is the main drainage system for the uncinate process.
METHODS
A retrospective review of all surgically treated IPMNs at our institution after 2008 was performed. Preoperative radiological studies were reviewed by an abdominal radiologist who was blinded to the pathological results. In addition to the Fukuoka criteria, presence of UDD was recorded. Using multivariate analysis, the pathological significance of UDD in predicting advanced neoplasia [high grade dysplasia or invasive carcinoma (HGD/ IC)] was determined.
RESULTS
Two hundred sixty patients were identified (mean age at diagnosis was 68 years and 49% were females): 122 (47%) had HGD/IC. UDD was noted in 59 (23%), of which 36 (61%) had HGD/IC (P < 0.003). On multivariate analysis, UDD was an independent predictor of HGD/IC (odds ratio = 2.99, P < 0.04). Subgroup analysis on patients with IPMNs confined to the dorsal portion of the gland (n = 161), also demonstrated UDD to be a significant predictor of HGD/IC in those remote lesions (odds ratio: 4.41, P = 0.039).
CONCLUSIONS
This is the largest study to evaluate the significance of UDD in IPMNs and shows it to be a high-risk feature. This association persisted for remote IPMNs limited to the dorsal pancreas, suggesting UDD may be associated with an aggressive phenotype even in remote IPMN lesions.
Identifiants
pubmed: 33201115
pii: 00000658-202206000-00037
doi: 10.1097/SLA.0000000000004307
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e789-e795Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interests to disclose.
Références
Ban S, Naitoh Y, Mino-Kenudson M, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol 2006; 30:1561–1569.
Fonseca A, Kirkwood K, Kim M, et al. Intraductal papillary mucinous neoplasms of the pancreas. Pancreas 2018; 47:272–279.
Kaimakliotis P, riff B, Pourmand K, et al. Sendai and Fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol 2015; 13:1808–1815.
Crippa S, Bassi C, Salvia R, et al. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut 2017; 66:495–506.
Hsiao C, Yang C, Wu J, et al. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Medicine 2016; 95:e4922.
Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12:183–197.
Tanaka M, Fernandez-del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17:738–753.
Singhi A, McGrath K, Brand R, et al. Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut 2017; 67:2131–2141.
Goh BKP, Tan DMY, Thng CH, et al. Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients. Ann Surg Oncol 2014; 21:1919–1926.
Yamada S, Fujii T, Murotani K, et al. Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms. Surgery 2016; 159:878–884.
Slack JM. Developmental biology of the pancreas. Development 1995; 121:1569–1580.
Schmitt F, Maignan A, Ploteau S, et al. New anatomical data on the drainage patterns of the uncinate process of the pancreas. Surg Radiol Anat 2010; 32:777–781.
Takahashi S, Akita K, Goseki N, et al. Spatial arrangement of the pancreatic ducts in the head of the pancreas with special reference to the branches of the uncinate process. Surgery 1999; 125:178–185.
Maker A, Maker V. Isolated pancreatic uncinate duct IPMN. J Gastrointest Surg 2017; 21:744–745.
Ammori J, Do R, Brennan M, et al. Uncinateduct dilationinintraductal papillary mucinous neoplasms of the pancreas: a radiographic finding with potentially increased malignant potential. J Gastrointest Surg 2014; 18:911–916.
Takaori K. Revisions of the international consensus Fukuoka guidelines for the management of IPMN of the pancreas: progress for twelve years. Pancreatology 2017; 17:645–646.
Basturk O, Hong SM, Wood LD, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol 2015; 39:1730–1741.
Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary mucinous neoplasms. In: Hamilton SR, Aaltonen LA, eds. Pathology and Genetics of Tumours of the Digestive System. WHO Classification of Tumours. Lyon, France: IARC Press; 2000:237–240.
Hruban RH, Boffeta P, Hiraoka N, et al. Ductal adenocarcinoma of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO classification ofTumours ofthe Digestive System. Lyon, France: IARC Press; 2010:281–291.
Klibansky DA, Reid-Lombardo KM, Gordon SR, et al. The clinical relevance of the increasing incidence of intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol 2012; 10:555–558.
Del Chiaro M, Ateeb Z, Hansson M, et al. Survival analysis and risk for progression of intraductal papillary mucinous neoplasia of the pancreas (IPMN) under surveillance: a single-institution experience. Ann Surg Oncol 2016; 24:1120–1126.
Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neo-plastic pancreatic cysts. Gastroenterology 2015; 148:819–822.
Attiyeh MA, Fernandez-Del Castillo C, Al Efishat M, et al. Development and validation of a multi-institutional preoperative nomogram for predicting grade of dysplasia in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Ann Surg 2018; 267:157–163.
Correa-Gallego C, Do R, LaFemina J, et al. Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol 2013; 20:4348–4355.
Sugimoto M, Elliott IA, Nguyen AH, et al. Assessment of a revised management strategy for patients with intraductal papillary mucinous neoplasms involving the main pancreatic duct. JAMA Surg 2017; 152:1–7.
Pulvirenti A, Margonis GA, Morales-Oyarvide V, et al. Intraductal papillary mucinous neoplasms: have IAP consensus guidelines changed our approach?: Results from a multi-institutional study. Ann Surg 2021; 274:e980–e987.
Wilson GC, Maithel SK, Bentrem D, et al. Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multiinstitutional study. J Am Coll Surg 2017; 224:461–469.
Baiocco J, Ackerman C, Crawford J, et al. Intraductal papillary mucinous neoplasm and pancreas divisum: two cases. J Pancreat Cancer 2016; 2:28–31.
Xiao S. Intraductal papillary mucinous neoplasm of the pancreas: an update. Scidentifica 2012; 1–20.
Scarpa A, Real F, Luchini C. Genetic unrelatedness of co-occurring pancreatic adenocarcinomas and IPMNs challenges current views of clinical management. Gut 2018; 67:1561–1563.
Izawa T, Obara T, Tanno S, et al. Clonality and field cancerization in intraductal papillary-mucinous tumors of the pancreas. Cancer 2001; 92:1807–1817.
Yamaguchi K, Kanemitsu S, Hatori T, et al. Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas 2011; 40:571–580.