Multicenter Analysis of Clinicopathologic Features of Intraductal Papillary Mucinous Tumor of the Pancreas: Is It Possible to Predict the Malignancy Before Surgery?

Jang, Jin Young; Kim, Sun Whe; Ahn, Young Joon; Yoon, Yoo Seok; Choi, Min Gew; Lee, Kuhn Uk; Han, Joon Koo; Kim, Woo Ho; Lee, Young Joo; Kim, Song Chul; Han, Duck Jong; Kim, Yong Il; Choi, Seong Ho; Cho, Baik Hwan; Yu, Hee Chul; Yoon, Dong Sup; Lee, Woo Jung; Lee, Kyung Bum; Kim, Young Chul; Lee, Kwang Soo; Kim, Myung Wook; Kim, Hee Jin; Kim, Hyun Jong; Park, Yong Hyun

doi:10.1245/aso.2005.02.030

Cited by 105 publications

(79 citation statements)

References 27 publications

(26 reference statements)

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“…The distribution of invasive IPMNs among the three subtypes was as follows: branch duct 30%, main duct 25%, and mixed variant 25%. On the other hand, in the series of Jang et al [8] , of 208 patients, more than 50% showed the macroscopic appearance of main-duct type. Likewise, D'Angelica et al [5] noted that 69% of patients with IPMNs had the main-duct type.…”

Section: Histopathological Features Of Ipmnsmentioning

confidence: 85%

“…Despite the signifi cant male predominance noted in early publications, current reports have described equal gender distribution [2,[4][5][6][7] . However, a recent publication of a large retrospective study from Asia showed a continued male predominance in this population, which raises the question of whether or not a geographic variation exists for IPMNs [8] . Interestingly, the median age of patients with IPMNs is two decades older than that of patients with chronic pancreatitis.…”

Section: Demographicsmentioning

confidence: 89%

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Intraductal Papillary Mucinous Neoplasms of the Pancreas

Al‐Refaie¹,

Choi²,

Tseng³

et al. 2006

Med Princ Pract

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The introduction of the exocrine pancreatic classification by the World Health Organization and improvements in pancreatic imaging have led to an improved understanding of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. As a result, IPMNs of the pancreas are increasingly being recognized as a separate disease entity. IPMNs are characterized by the cystic dilatation of the pancreatic duct and its branches, with papillary projections. There are three histological subtypes of IPMNs: main duct, branch duct, and mixed. The degree of atypia ranges from adenoma to frank invasive carcinoma. The lymph nodes are involved considerably less frequently than they are in pancreatic adenocarcinoma. Most patients are symptomatic at diagnosis and require a diagnostic workup similar to that for patients with pancreatic adenocarcinoma. Although some investigators continue to advocate total pancreatectomy, the evidence in support of this is decreasing. Partial pancreatectomy remains the treatment option. Intraoperative assessment of the resection surgical margins is an important component of surgical resection. Additionally, controversy also exists regarding the nature of the follow-up and the need for adjuvant chemoradiation therapy in the patient. Unlike ductal adenocarcinomas, IPMNs follow a relatively indolent course; the 5-year survival rate in patients with invasive IPMNs is 57%. A mural nodule and a main pancreatic duct diameter greater than 5 mm have been found to be predictors of malignancy.

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Section: Histopathological Features Of Ipmnsmentioning

confidence: 85%

Section: Demographicsmentioning

confidence: 89%

Intraductal Papillary Mucinous Neoplasms of the Pancreas

Al‐Refaie¹,

Choi²,

Tseng³

et al. 2006

Med Princ Pract

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“…These values were superior to those of CT parameters that had been reported previously to be associated with a higher likelihood of malignancy (5,(9)(10)(11)(12)(13)(14)(15)(16)(17), including large cystic lesion size (≥3.0 vs. <3.0 cm), and large dilatation of MPD (≥7 vs. <7 mm) (Table II). In comparison to the presence/absence of mural nodules, which is also previously reported to be associated with malignancy, though the sensitivity was almost equal, the specificity and accuracy were superior (Table II).…”

Section: ------------------------------------------------------------mentioning

confidence: 63%

“…Therefore, preoperative differentiation between benign IPMN and malignant IPMN is important in order to determine the management of patients. To date, various features of malignant IPMN tumors using imaging techniques have been proposed, such as large lesion size, dilatation of the main pancreatic duct (MPD), and presence of mural nodules (5,(9)(10)(11)(12)(13)(14)(15)(16). However, some of these features are controversial, and their accuracy depends on the imaging modalities used.…”

Section: Introductionmentioning

confidence: 99%

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary-mucinous neoplasm of the pancreas

et al. 2010

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Abstract. Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas presents in various histopathological stages from benign to malignant lesions. The differentiation between benign and malignant IPMN is important in order t o determine the treatment of the patients. However, preoperative differentiation remains difficult. The aim of this study was to assess the utility of 2-[18 F] fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET) in preoperative differentiation of benign and malignant IPMN of the pancreas. In the present study we prospectively investigated 29 patients who underwent CT, FDG-PET, and surgery for IPMNs, followed by histopathological examination. The maximum standardized uptake value (SUVmax) was determined on FDG-PET, and differentiation of benign from malignant IPMN was tested using various SUVmax cut-off levels and various parameters derived from the CT. SUVmax was found to be significantly higher in malignant IPMNs (4.7±3.0) than that in benign IPMNs (1.8±0.3, P=0.0011). SUVmax values correlated with the histopathological types of IPMN (adenoma/borderline lesion/carcinoma in situ/invasive carcinoma) (Spearman rank correlation 0.865, P<0.0001). The specificity, sensitivity and accuracy values were best for SUVmax of 2.5 (100, 93, and 96%, respectively). The combination of mural nodule, detected on CT, and SUVmax of 2.5 offered the best diagnosis of malignant IPMN. These results suggest that FDG-PET is useful for differentiation of malignant IPMN of the pancreas, and that it should be performed in combination with other conventional imaging modalities.

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“…Chari and colleagues 127 concluded from their study of recurrence after surgical resection of IPMNs that for invasive lesions, recurrence rates were similar after partial pancreatectomy (18 of 27 cases, 67%) and total pancreatectomy (8 of 13 cases, 62%). Jang and colleagues 119 reached the same conclusion in their multicenter analysis of surgical outcomes for IPMNs, finding similar recurrence rates following total pancreatectomy (37.5%) and partial pancreatic resections (32.5%) for invasive disease.…”

Section: Managementmentioning

confidence: 62%

Cystic Neoplasms of the Pancreas

et al.

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Whereas pancreatic duct adenocarcinoma (PDA) is a well-studied (but still poorly understood) disease with a dismal prognosis, cystic neoplasms of the pancreas form a more recently recognized group of pancreatic tumors. They are diverse and variable in their pathologic characteristics, clinical course, and outcomes, 1-3 although all portend a better overall prognosis than PDA. In recent years, with the improved sensitivity and increasing use of cross-sectional imaging in clinical practice, these lesions are more commonly identified, 4 with many being discovered incidentally. Indeed, large radiological series using computed tomography (CT) or magnetic resonance imaging (MRI) have reported detection rates of pancreatic cystic lesions between 1.2% and almost 20%, 5,6 approaching the 24.3% prevalence rate in an autopsy series by Kimura and colleagues. 7 Although most of these lesions are pseudocysts, a significant portion consist of cystic neoplasms, which are estimated to represent 10% to 15% of all primary pancreatic cystic lesions. 8 Given the growing clinical relevance of these tumors, a keen understanding of their natural history and pathophysiology is needed. This article reviews pancreatic cystic neoplasms, with a focus on the challenges encountered in their diagnosis and treatment. KeywordsPancreatic cystic neoplasm; Serous cystic neoplasm; Mucinous cystic neoplasm; Intraductal Papillary mucinous neoplasm Pancreatic Cystic NeoplasmsAlthough pancreatic cystic neoplasms (PCNs) are often discussed together, it is important to realize that they are a heterogeneous group of tumors with wide-ranging malignant potential,

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Multicenter Analysis of Clinicopathologic Features of Intraductal Papillary Mucinous Tumor of the Pancreas: Is It Possible to Predict the Malignancy Before Surgery?

Cited by 105 publications

References 27 publications

Intraductal Papillary Mucinous Neoplasms of the Pancreas

Intraductal Papillary Mucinous Neoplasms of the Pancreas

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary-mucinous neoplasm of the pancreas

Cystic Neoplasms of the Pancreas

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