Diagnostic significance of a dilated orifice of the duodenal papilla in intraductal papillary mucinous neoplasm of the pancreas

Lee²,

et al. 2014

Pancreas

Objective: We evaluated the accuracy of a new endoscopic ultrasonography (EUS) scoring system to predict malignancy in branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs).Methods: We performed a retrospective multicenter study of patients who underwent EUS within 3 months before surgery and were diagnosed as having BD-IPMNs by postoperative pathologies at 8 hospitals in Korea from August 2002 to December 2011. To predict the malignancy, we applied the EUS scoring system consisting of pancreatic cyst size, height of mural nodules, main duct dilatation, septal thickening, and patulous orifice. We evaluated the diagnostic accuracy of the new EUS scoring system and compared it with previous individual risk factors.Results: Eighty-four patients (male-to-female ratio, 55:29; mean [SD] age, 64.7 [7.1] years) had 68 benign BD-IPMNs and 16 malignant intraductal papillary mucinous neoplasms. The EUS scoring system showed 75.0% sensitivity and 94.1% specificity at 7 points. This system (area under the curve, 0.939; 95% confidence interval, 0.884-0.994) resulted in a more accurate prediction than the previous known other factors including Sendai criteria, dilatation of ducts, size of the cyst, and presence of septal thickening and mural nodules.Conclusions: The EUS scoring system predicted BD-IPMN malignancy more accurately than the Sendai criteria and individual risk factors.Key Words: endoscopic ultrasonography, branch duct-type intraductal papillary mucinous neoplasm, malignancy, diagnostic accuracy (Pancreas 2014;43: 1306-1311 I ntraductal papillary mucinous neoplasms (IPMNs) of the pancreas are grossly detectable, mucin-producing, and potentially malignant pancreatic cystic neoplasms. Intraductal papillary mucinous neoplasms are pathologically graded according to the most atypical area in the lesion such as low-grade adenoma, moderate dysplasia, carcinoma in situ, and invasive carcinoma. The prognosis of low-grade adenoma and moderate dysplasia is good but that of carcinoma is similar to pancreatic cancers.If the IPMN involves the main pancreatic duct, the risk for malignancy is 57% to 92%. However, in the case of branch duct-type IPMN (BD-IPMN), the risk for malignancy varies. Several factors have been suggested to discriminate a malignancy from benign BD-IPMN. 1 Abdominal pain, jaundice, pancreatitis, and abrupt onset diabetes mellitus are clinically related with malignancy. In radiological findings, the risk for malignancy is high if a large cyst (>30 mm) is present, the main pancreatic duct is dilated, and solid components such as mural nodules, infiltrative mass, or a thickened septum exist.Several criteria for surgically managing a pancreatic cystic neoplasm have been suggested, but predicting the malignancy of BD-IPMN before surgery is still challenging. The Sendai criteria are the most widely accepted to determine whether a surgical resection of BD-IPMN is indicated, but the frequency of malignancy is 28% when they are applied to resected cases. 2 Endoscopic ultrasonography (EUS) is the best ...

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

Lee²,

et al. 2014

Pancreas

J of Gastro and Hepatol

“…Small bowel neoplasms were also detected in patients with Lynch syndrome . According to a recent retrospective analysis from Japan, a dilated papilla may have diagnostic significance in intraductal papillary mucinous neoplasm of the pancreas . However, the inability to visualize the duodenal papilla is an inherent limitation of capsule endoscopy.…”

Section: Introductionmentioning

confidence: 99%

First clinical trial of a newly developed capsule endoscope with panoramic side view for small bowel: A pilot study

Friedrich

Gehrke

Stremmel

et al. 2013

“…The values obtained appear better than those of reported predictors for intestinal-type IPMNs such as a history of acute pancreatitis (sensitivity, 33%; specificity, 96%) and a dilated orifice of the duodenal papilla (sensitivity, 78%; specificity, 61%). 13,14 MicroRNAs are considered to be suitable as stable biomarkers in pancreatic juice samples, whereas there are some difficulties in analyzing biomarkers such as proteins or mRNAs due to the enzymatic activities of the pancreatic juice.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, although disease subtype is not currently included in the international consensus guidelines for the management of IPMN, 3 it would be ideal to determine the surgical indication of IPMNs based on assessment of both IPMN subtype and malignant grade in the future. Certain clinical factors, such as a history of acute pancreatitis 13 or a dilated orifice of the duodenal papilla, 14 have been reported as preoperative predictors of intestinal-type IPMNs. However, there have been few reports mentioning molecular biological factors predictive of intestinal subtype.…”

mentioning

confidence: 99%

Elevated Expression Level of MicroRNA-196a Is Predictive of Intestinal-Type Intraductal Papillary Mucinous Neoplasm of the Pancreas

Aso¹,

Ohtsuka²,

Tamura³

et al. 2014

Pancreas

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