Diagnostic performance of magnetic resonance image for malignant intraductal papillary mucinous neoplasms: the importance of size of enhancing mural nodule within cyst

Hong, Seung Baek; Lee, Nam Kyung; Kim, Suk; Seo, Hyung-Il; Park, Young Mok; Noh, Byeong Gwan; Kim, Dong Uk; Han, Sung Yong; Kim, Tae Un

doi:10.1007/s11604-022-01312-y

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Sohn et al ( 2001 ) found invasive growth in 37% (22/60). In Asian studies, the proportion of benign IPNM was usually around 50% (Hirono et al 2020 ; Hong et al 2022 ; Min et al 2020 ). The malignant potential for main duct IPMN is reported to be 60–80% (Vege et al 2015 ), in secondary duct IPMN, 3–26% (Vege et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Rare tumours of the pancreas: monocentric study

Bauschke,

Altendorf-Hofmann,

Ali-Deeb

et al. 2024

J Cancer Res Clin Oncol

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Purpose The biology of rare pancreatic tumours, which differs from that of ductal pancreatic cancer, requires increased attention. Although the majority of rare pancreatic tumours are benign, it is difficult to decide whether an invasive component exists without complete removal of the lesion, despite considerable progress in diagnosis. We are investigating a large cohort of patients with histologically confirmed epithelial non-ductal non-neuroendocrine neoplasms of the pancreas. Methods Here we analyze long-term survival from patients, who underwent resection of histologically confirmed epithelial non-ductal non-neuroendocrine neoplasms of the pancreas. At our department between Jan 1st, 1999, and Dec 31st, 2019. The median follow-up was 61 (range 0–168) month. All statistical analyses were performed using SPSS 26.0 (IBM, Chicago, IL, USA) software. Results 46 patients (48%) were followed up for more than 5 years, 18 patients (19%) for more than 10 years. The 5-year and 10-year survival rates for rare non-invasive pancreatic tumours were 72% and 55% respectively. The proportion of rare tumour entities (non-ductal and non-neuroendocrine) increased continuously and statistically significantly (p = 0.004) from 4.2 to 12.3% in our clinic between 1999 and 2019. If there is no invasive growth yet, there is a varying risk of malignant degeneration in the course of the disease. Therefore, the indication for pancreatic resection is still the subject of discussion. Conclusion The long-term prognosis of rare epithelial pancreatic tumours after R0 resection—even if they are already malignant—is much better than that of ductal pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Rare tumours of the pancreas: monocentric study

Bauschke,

Altendorf-Hofmann,

Ali-Deeb

et al. 2024

J Cancer Res Clin Oncol

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“…Multiphase CT radiomics could further improve the diagnosis of malignant IPMNs [ 41 ]. MRI is important for detecting malignancy of IPMNs by enhancing mural nodules equal to or greater than 5 mm [ 42 ] or detecting pancreatic atrophy [ 43 ]. They are the first-choice diagnostic imaging modalities for further evaluation of any suspected lesion of the pancreas followed by EUS.…”

Section: Diagnosismentioning

confidence: 99%

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Pavlidis

Sapalidis²,

Pavlidis³

2022

Rom J Morphol Embryol

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Intraductal papillary mucinous neoplasms (IPMNs) account for approximately 35% of all cystic tumors in the pancreas and represent the largest subgroup. They are characterized by mucin production and intraductal papillary epithelium growth. IPMNs range from benign to malignant lesions. Biomarkers combined with 18F-Fluorodeoxyglucose–positron emission tomography (18FDG–PET) is the best diagnostic tool. The risk of malignant transformation for main-duct IPMNs is between 34–68% and for low-risk branch-duct (BD)-IPMNs it is 1.1%. Monitoring is crucial for determining the optimal time of surgical excision. Novel artificial intelligence combining clinical, tumor biomarkers, imaging and molecular genomics plays a determinant role in the evaluation of such lesions. The first diagnostic tool is multidetector helical computed tomography (MDHCT) or up-to-date magnetic resonance imaging (MRI). MRI detects malignancy by enhancing mural nodules ≥3 mm. Novel endosonographic interventional techniques have been added to the diagnostic armamentarium. Pancreatoscopy is feasible and effective but challenging for evaluating the diagnosis, invasiveness, and extent of IPMNs. Its findings may change the surgical approach. Pancreatic juice and duodenal fluid have been used recently for molecular biological analysis. The genes most frequently altered include Kirsten rat sarcoma viral proto-oncogene (KRAS), tumor protein p53 (TP53), cyclin-dependent kinase inhibitor 2A (CDKN2A), SMAD family member 4 (SMAD4), and guanine nucleotide-binding protein, alpha stimulating (GNAS). Despite the advances in diagnostic modalities, assessment of this premalignant lesion of pancreatic cancer, with its poor prognosis, is a challenging task. Pancreatectomy is the indicated approach for malignant or high-risk IPMNs with potent malignancy. Conservative management or enucleation for preserving the pancreas of low-risk BD-IPMNs is recommended, but long-term follow-up for recurrence is necessary. The management of IPMNs must be individualized based on preoperative high-risk stigmata and worrisome features.

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