Systematic review and meta-analysis of the spectrum and outcomes of different histologic subtypes of noninvasive and invasive intraductal papillary mucinous neoplasms

Koh, Ye‐Xin; Zheng, Hui; Chok, Aik Yong; Tan, Chuen Seng; Wyone, Wyiki; Lim, Tony Kiat Hon; Tan, Dawn; Goh, Brian K.P.

doi:10.1016/j.surg.2014.08.098

Cited by 66 publications

(40 citation statements)

References 46 publications

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“…Gastric subtype (38.5% of our cases; literature 35.5 to 46.1%) is typically associated with low-grade dysplasia, as can be seen in our series, but when there is malignant transformation, tumors tend to be more aggressive (tubular type) (6,(12)(13). The pancreaticbiliary subtype (35.9% of our cases; literature 11.3 to 14.6%) is less well characterized and when carcinoma develops, is also more aggressive (11)(12). On the other hand, the intestinal subtype (10.3% of our patients; literature 26.6 to 34.6%) is most often associated with high-grade dysplasia or malignant transformation, but has an indolent behavior (6,12).…”

Section: Discussion Discussionsupporting

confidence: 62%

“…The pancreaticbiliary subtype (35.9% of our cases; literature 11.3 to 14.6%) is less well characterized and when carcinoma develops, is also more aggressive (11)(12). On the other hand, the intestinal subtype (10.3% of our patients; literature 26.6 to 34.6%) is most often associated with high-grade dysplasia or malignant transformation, but has an indolent behavior (6,12). In our series, all cases …”

Section: Discussion Discussionmentioning

confidence: 56%

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Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

Devezas¹,

Queiros²,

Teixeira³

et al. 2018

SGO

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Introduction: Pancreatic intraductal papillary mucinous neoplasms (IPMN) are recognized as pre-malignant lesions, corresponding to less than 3% of all pancreatic exocrine neoplasms. The study objectives were: to evaluate the surgical results of our institution, to identify factors predicting malignancy in IPMN and to assess the validity of recently introduced IPMN guidelines in our population. Methods: A single center, retrospective study in patients submitted to surgical resection for IPMN was conducted, between 1/2008-6/2016, to identify predictive factors for malignancy, and to evaluate the surgical results. Results: Thirty-nine patients were submitted to a surgical resection. The median age was 68 years (61.5% females). Adenocarcinoma and high-grade dysplasia were present, in 7 and 4 patients, respectively. A significant association was identified with the phenotype and the degree of atypia (p = 0.001), and duct origin and degree of atypia (p = 0.026). Malignant transformation was associated with intestinal or pancreatic-biliary subtypes. Discussion and Conclusions: Applying the European guidelines, all adenocarcinoma would have undergone surgical resection, but 1 with high-grade dysplasia would not be resected. If we applied the American guidelines, 1 patient with adenocarcinoma and 3 with high-grade dysplasia wouldn´t be submitted to resection. The decision in patients with these lesions requires multidisciplinary teams and a tailored based approach.

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Section: Discussion Discussionsupporting

confidence: 62%

Section: Discussion Discussionmentioning

confidence: 56%

Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

Devezas¹,

Queiros²,

Teixeira³

et al. 2018

SGO

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“…[5][6][7][8] Furthermore, studies have reported conflicting evidence on whether the histologic IPMN subtype has prognostic significance. [8][9][10][11][12] The Verona consensus meeting in 2013 recently led to the publication of guidelines for pathologic reporting of IPMN with the recommendation that pathologists provide a histologic subtype. 13 Although most previous studies used morphology and immunohistochemistry to designate the IPMN subtype, this is not necessarily implemented as standard practice.…”

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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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“…These types are characterized by different histologic features, specific mucin expression, and different genetic drivers. Eventually, IPMNs can progress to invasive carcinoma through 3 different patterns: ductal/tubular, colloid/muco-nodular, and oncocytic [12-15]. …”

Section: Introductionmentioning

confidence: 99%

“…MD-IPMNs are frequently associated with an epithelium of the intestinal-type, and harbor a high likelihood of malignant progression. However, when carcinoma occurs, this is most likely of the biologically less aggressive colloid type [12, 13]. The gastric epithelial subtype, which is less common for MD-IPMN, has a lower likelihood of progression into invasive cancer.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Management of Main Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas

Borgo¹,

Perri²,

Borin³

et al. 2018

Dig Surg

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Background: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas comprise a heterogeneous group of intraductal mucin-producing neoplasms representing a typical adenoma-to-carcinoma sequence. The involvement of the main pancreatic duct (MPD) is a feature of paramount importance, directly related to a more aggressive biology and a higher malignancy rate. Method: We review and discuss the clinical management of IPMNs with a MPD involvement, recalling the different consensus guidelines and addressing recent controversies in literature, presenting the current clinical practice in Verona Pancreas Institute. Results: All the aspects of surgical management were discussed, from the indication for surgery to the intraoperative management and the follow-up strategies. Conclusion: The management of presumed IPMNs involving the MPD at our Institution is in line with the International Association of Pancreatology 2012 guidelines, revised in 2016. Surgical resection proposed should achieve the complete removal of the tumor with negative margins. Despite a good prognosis in terms of survival of overall resected main duct intraductal papillary mucinous neoplasms, follow-up should not be discontinued.

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Systematic review and meta-analysis of the spectrum and outcomes of different histologic subtypes of noninvasive and invasive intraductal papillary mucinous neoplasms

Cited by 66 publications

References 46 publications

Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

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

The Clinical Management of Main Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas

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