Criteria for Determining Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasm Based on Computed Tomography

Abstract

Introduction: Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated. Patients and Methods: Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; n = 28) and malignant (mIPMN; n = 19) tumors, and a summation score was determined. Results: Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN (p = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN (p < 0.0001). More patients with mIPMN showed bile duct obstruction (p = 0.0076), solid tumor components (p = 0.0076), contrast enhancement in cystic walls (p = 0.0086), peripancreatic lymph nodes (p = 0.0076), and abrupt diameter changes of the main pancreatic duct (p = 0.0008). The CT density of the cysts was higher in mIPMN (p = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter. Conclusions: The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy.

Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management

“…Monnings et al [ 27 ] analyzed preoperative CT scans in IPMN patients. Benign (bIPMN; n = 28) and malignant (mIPMN; n = 19) tumors were compared.…”

“…In addition, in mIPMN, the CT cyst density was higher ( P = 0.0063). The summary diagnostic accuracy was higher than all single CT parameters[ 27 ].…”

Diagnostik und Therapie von zystischen Pankreastumoren

“…Aufgrund ihrer breiten Verfügbarkeit und Standardisierung ist die dünnschichtige kontrastmittel-(KM-)verstärkte CT mit arterieller und portalvenöser Phase eines der wichtigsten Untersuchungsverfahren. Sie verfügt über eine hohe Genauigkeit bei der Beschreibung malignomsuspekter Befunde und deren Bezug zu benachbarten parenchymatösen Organen und Gefäßstrukturen [4]. In der WHO-Klassifikation 2010 werden 4 histologische prognoserelevante Subtypen unterschieden (▶ Tab.…”

“…Bis zu 30 % der präoperativen Verdachtsdiagnosen bestätigen sich nicht durch die endgültige Histologie [35]. Ebenso ist die Beurteilung des Malignitätsrisikos bildmorphologisch unsicher [1][2][3][4]20]. Zusätzliche Kriterien wie Tumormarkererhöhungen von CA 19-9 und CEA oder eine positive Familienanamnese für maligne Erkrankungen können die Erkennung von malignen zystischen Läsionen im Pankreas erleichtern [11,21].…”