Preoperative Histological Subtype Classification of Intraductal Papillary Mucinous Neoplasms (IPMN) by Pancreatic Juice Cytology With MUC Stain

Hara, Taro; Ikebe, Dai; Odaka, Akiko; Sudo, Kentaro; Nakamura, Kazuyoshi; Yamamoto, Hiroshi; Itami, Makiko; Hirata, Tetsuya; Kashimura, Junya; Yamaguchi, Taketo

doi:10.1097/sla.0b013e318281b824

Cited by 48 publications

(27 citation statements)

References 45 publications

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“…Interestingly, classification of IPMN subtypes has been attempted preoperatively through immunohistochemical studies of pancreatic juice cytology by Hara et al 28 Histological IPMN subtype diagnosed with pancreatic juice cytology was compared with the subtype diagnosis made at resection. With the use of MUC1, MUC2, and MUC5AC immunostains, the histological IPMN subtype was correctly diagnosed in 89% of cases (32/36) with a sensitivity and specificity of 86 and 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

et al. 2016

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Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ = 0.41, Po 0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ = 0.56, Po 0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ = 0.43, Po 0.01; κ = 0.38, Po 0.01; κ = 0.17, Po 0.01; κ = 0.08, Po 0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

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Section: Discussionmentioning

confidence: 99%

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

et al. 2016

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“…Previous studies reported that several predictors for development of concomitant PDAC: older age >70 years [16], elevated serum CA19-9 level or worsening of diabetes [17]. Recently, Ideno et al reported gastrictype IPMN without GNAS mutation [22] as a predictor, which could be assessed preoperatively [23,24].…”

Section: Q9mentioning

confidence: 96%

Imaging morphological changes of intraductal papillary mucinous neoplasm of the pancreas was associated with its malignant transformation but not with development of pancreatic ductal adenocarcinoma

et al. 2015

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“…Finally, recent advances with histological subtyping in combination with endoscopic techniques are allowing for what may be a reliable means of preoperatively risk stratifying patients [50] . Pancreatobiliary type IPMNs usually affect the main duct and demonstrate higher rates of high-grade dysplasia, higher rates of malignant transformation and higher rates of recurrence, even when resected as non-invasive neoplasms.…”

Section: Discussion: Who Should Undergo Tp For Ipmn?mentioning

confidence: 99%

“…Preoperative identification of pancreatobiliary or intestinal type would be beneficial for risk stratification and planning the type and extent of resection best suited for a patient. In a recent study by Hara et al [50] , histological subtype was successfully diagnosed preoperatively by pancreatic juice cytology with MUC stain in 89% (32 of 36; p < 0.01). The sensitivity, specificity and overall accuracy of this method were 86, 100 and 94% for intestinal subtype, respectively.…”

Section: Risk Factors For Recurrence Margin Statusmentioning

confidence: 99%

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Griffin

Poruk

Wolfgang³

2016

Dig Surg

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Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer. As an alternative, total pancreatectomy (TP) provides the most complete oncologic resection, but postoperative morbidity and quality of life (QoL) issues have generally limited its use to only the highest risk patients. Significant progress has been made in the management of the post-TP apancreatic state and studies now show less morbidity with acceptable QoL comparable to type 1 diabetic and post-pancreaticoduodenectomy patients. These improvements do not yet justify the routine use of TP, but they have opened the door for expansion to additional subsets of non-invasive IPMN. Here, we have identified several groups of patients that we believe would benefit from TP over partial resection based on the most current literature.

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Preoperative Histological Subtype Classification of Intraductal Papillary Mucinous Neoplasms (IPMN) by Pancreatic Juice Cytology With MUC Stain

Abstract: Preoperative PJC with MUC stain proved to be highly reliable for identifying the histological subtype of IPMN and may provide useful information for deciding surgical indication.

Cited by 48 publications

References 45 publications

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

Imaging morphological changes of intraductal papillary mucinous neoplasm of the pancreas was associated with its malignant transformation but not with development of pancreatic ductal adenocarcinoma

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

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