Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time

Castelli, Federica; Bosetti, D.; Negrelli, Riccardo; Paola, Valerio Di; Zantedeschi, Lisa; Ventriglia, Anna; Manfredi, Riccardo; Mucelli, Roberto Pozzi

doi:10.1007/s11547-013-0945-8

Cited by 20 publications

(21 citation statements)

References 28 publications

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“…Imaging evolution included development of alert findings in 8.3% of patients, a value within the range of those previously reported in studies with MRCP (2.7%-10.8%)[19-22] or combined imaging modalities (4.9%-9%)[14,17]. None of them corresponded to “high-risk stigmata” according to Sendai guidelines definition, but rather to worrisome features[1].…”

Section: Discussionsupporting

confidence: 67%

Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

Girometti¹,

Pravisani²,

Intini³

et al. 2016

WJG

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AIMTo investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up.METHODSWe retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes.RESULTSWe found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (< 10 mm) increase and/or decrease of cysts size at a median time of 22.5 mo. Alert findings developed in 6/72 patients (8.3%; 95%CI: 3.4-17.9) over a wide interval of time (13-63 mo). No malignancy was found on endoscopic ultrasound with fine-needle aspiration (5/6 cases) or surgery (1/6 cases). No clinical or initial MRCP features were significantly associated with changes in bd-IPMN appearance (P > 0.01).CONCLUSIONChanges in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy.

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Section: Discussionsupporting

confidence: 67%

Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

Girometti¹,

Pravisani²,

Intini³

et al. 2016

WJG

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“…The possibility of malignant degeneration is strongly dependent on the site of origin because MD-IPMNs show a risk of progression of 60–92%, whereas IPMNs arising from secondary branches have a lower value of degeneration, approximately 6–40% [22, 23]. …”

Section: Cross-sectional Imaging Featuresmentioning

confidence: 99%

“…Both diffuse and segmental primary IPMNs have been associated with malignancy in the case of mural nodules or internal solid components [3–5, 22, 29]. The presence of solid components with enhancement after contrast administration has been reported as “high-risk stigmata” [28].…”

Section: Cross-sectional Imaging Featuresmentioning

confidence: 99%

“…The demonstration of the communication with the main pancreatic duct is a sign of differentiation from other cystic lesions such as the mucinous cystadenoma. However, the communication with main duct is often not appreciable on MR images [3, 22]. …”

Section: Cross-sectional Imaging Featuresmentioning

confidence: 99%

“…In this pattern of morphological presentation, IPMNs are divided into five classes: diffuse, proximal, proximally diffuse, distal, and bridge morphology [22]. The multifocality of IPMNs is responsible for an increased cumulative risk of neoplastic degeneration [32].…”

Section: Cross-sectional Imaging Featuresmentioning

confidence: 99%

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The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

Palmucci

Trombatore

Foti

et al. 2014

Gastroenterology Research and Practice

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Intraductal papillary mucinous neoplasms (IPMNs) represent a group of cystic pancreatic neoplasms with large range of clinical behaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesions originating from the main pancreatic duct, main duct IPMNs (MD-IPMNs), and lesions which arise from secondary branches of parenchyma, denominated branch-duct IPMNs (BD-IPMNs). Management of these cystic lesions is essentially based on clinical and radiological features. The latter have been very well described in the last fifteen years, with many studies published in literature showing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or “worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm), large size (3–5 cm), and intramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic or macrocystic in appearance, with or without communication with main duct. Their imaging features are frequently overlapped with cystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very often proposed for these lesions.

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The World Health Organization classification of pancreaticobiliary cytopathology stratifies risk of malignancy and outcome for endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas

Lui,

Hargett,

Pharaa

et al. 2023

Cancer Cytopathology

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BackgroundThe World Health Organization (WHO) has recently published a classification for reporting pancreaticobiliary cytopathology with differences compared to the Papanicolaou Society of Cytopathology (PSC) classification.MethodsRetrospective data were collected from pancreatic endoscopic ultrasound‐guided fine‐needle aspirations from 2014 to 2017 at a pancreatic cancer center. Absolute risk of malignancy (AROM), relative risk (to benign), performance characteristics, and overall survival were calculated for the entire cohort with comparison of cysts and solid lesions.ResultsIn total, 2562 cases were included: 16% cyst (n = 411) and 84% solid (n = 2151). The histologic confirmation rate was 43% (n = 1101) and the median follow‐up (for benign) was 56 months. For WHO I–VII, overall AROM (%) was 23, 22, 62, 13, 65, 97, and 100; cyst AROM was 7, 0, 19, 13, 38, 78, and 100; and solid AROM was 50, 29, 70, 15, 100, 99, and 100. For PSC I–VI, overall AROM (%) was 23, 29, 64, 0 (IVa), 60 (IVb), 97, and 100; cyst AROM was 7, 0, 19, 0, 21, 78, and 100; and solid AROM was 50, 35, 73, 0, 92, 99, and 100. The difference in relative risk for a cyst (vs. solid) overall was 0.38 for WHO and 0.26 for PSC. WHO and PSC categories showed stratification for the probability of overall survival.ConclusionsCystic versus solid lesion type can dramatically affect AROM, particularly for nondiagnostic (I), benign (II), atypical (III), and WHO V categories. WHO IV conveys a similarly low AROM for cystic and solid types. Both classifications stratify the probability of overall survival, including the newly introduced categories WHO IV and WHO V.

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Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time

Cited by 20 publications

References 28 publications

Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

The World Health Organization classification of pancreaticobiliary cytopathology stratifies risk of malignancy and outcome for endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas

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