Preoperative Predictive Features of Invasive Carcinoma Among Intraductal Papillary Mucinous Neoplasm of the Pancreas.
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
15
7
2022
medline:
12
10
2022
entrez:
14
7
2022
Statut:
ppublish
Résumé
Noninvasive intraductal papillary mucinous neoplasms (IPMNs) theoretically do not metastasize. The purpose of this study is to preoperatively distinguish invasive carcinomas associated with IPMN from noninvasive IPMN. A total of 131 patients who underwent surgical resection for IPMN were retrospectively analyzed to identify the predictors of invasive carcinoma, based on the International Association of Pancreatology Consensus Guidelines. Of the 131 patients, 29 (22%) had invasive carcinomas and 102 (78%) had noninvasive IPMN. An enhancing mural nodule (MN) greater than or equal to 5 mm, obstructive jaundice, an abrupt change in the caliber of the pancreatic duct (PD) with distal pancreatic atrophy, and lymphadenopathy were the significant predictors of invasive carcinoma in univariate analysis. The optimal cutoff value for the size of the enhancing MN to differentiate invasive carcinoma was 13 mm. In multivariate analysis, enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were the independent predictors. When all these factors were absent, only 17% were invasive carcinomas. Enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were predictive factors for invasive carcinoma. Systematic lymph node dissection may be omitted when a high-risk patient has none of these factors.
Identifiants
pubmed: 35835103
doi: 10.1097/MPA.0000000000002078
pii: 00006676-202207000-00014
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
642-648Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg . 2004;239:788–797; discussion 797–799.
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.
Adsay V, Mino-Kenudson M, Furukawa T, et al. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of Verona consensus meeting. Ann Surg . 2016;263:162–177.
Hruban RH, Takaori K, Klimstra DS, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol . 2004;28:977–987.
Basturk O, Esposito I, Fukushima N, et al; WHO Classification of Tumours Editorial Board. Pancreatic intraductal papillary mucinous neoplasm. In: World Health Organization Classification of Tumours, 5th Edition. Digestive System Tumours . Lyon, France: IARC; 2019:310–314.
Kimura W, Makuuchi M, Kuroda A. Characteristics and treatment of mucin-producing tumor of the pancreas. Hepatogastroenterology . 1998;45:2001–2008.
Oyama H, Tada M, Takagi K, et al. Long-term risk of malignancy in branch-duct intraductal papillary mucinous neoplasms. Gastroenterology . 2020;158:226–237.e5.
Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology . 2006;6:17–32.
Tanaka M, Fernández-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, Fernández-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.
Fritz S, Klauss M, Bergmann F, et al. Pancreatic main-duct involvement in branch-duct IPMNs: an underestimated risk. Ann Surg . 2014;260:848–855; discussion 855–856.
Aso T, Ohtsuka T, Matsunaga T, et al. “High-risk stigmata” of the 2012 international consensus guidelines correlate with the malignant grade of branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas . 2014;43:1239–1243.
Jang JY, Park T, Lee S, et al. Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms. Br J Surg . 2014;101:686–692.
Kim KW, Park SH, Pyo J, et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg . 2014;259:72–81.
Yu S, Takasu N, Watanabe T, et al. Validation of the 2012 Fukuoka consensus guideline for intraductal papillary mucinous neoplasm of the pancreas from a single institution experience. Pancreas . 2017;46:936–942.
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 multi-institutional study. J Am Coll Surg . 2017;224:461–469.
Watanabe Y, Endo S, Nishihara K, et al. The validity of the surgical indication for intraductal papillary mucinous neoplasm of the pancreas advocated by the 2017 revised International Association of Pancreatology consensus guidelines. Surg Today . 2018;48:1011–1019.
Harima H, Kaino S, Shinoda S, et al. Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol . 2015;21:6252–6260.
Japan Pancreas Society. General Rules for the Study of Pancreatic Cancer . 7th ed. Tokyo, Japan: Kanehara; 2016.
Tsumura A, Hirono S, Kawai M, et al. Surgical indication for intraductal papillary mucinous neoplasm without mural nodule ≥5 mm. Surgery . 2020;169:388–395.
Kimura W, Miyata H, Gotoh M, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg . 2014;259:773–780.
Hirono S, Tani M, Kawai M, et al. The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg . 2012;255:517–522.
Shimizu Y, Yamaue H, Maguchi H, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas . 2013;42:883–888.
Ohno E, Hirooka Y, Itoh A, et al. Intraductal papillary mucinous neoplasms of the pancreas: differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules. Ann Surg . 2009;249:628–634.
Marchegiani G, Andrianello S, Borin A, et al. Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. Surgery . 2018;163:1272–1279.
Kawada N, Uehara H, Nagata S, et al. Mural nodule of 10 mm or larger as predictor of malignancy for intraductal papillary mucinous neoplasm of the pancreas: pathological and radiological evaluations. Pancreatology . 2016;16:441–448.
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.
Ma GK, Goldberg DS, Thiruvengadam N, et al. Comparing American Gastroenterological Association pancreatic cyst management guidelines with Fukuoka consensus guidelines as predictors of advanced neoplasia in patients with suspected pancreatic cystic neoplasms. J Am Coll Surg . 2016;223:729–737.e1.
Hirooka Y, Goto H, Itoh A, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol . 2003;18:1323–1324.