Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Arikawa, Shunji; Uchida, Masafumi; Uozumi, Jun; Sakoda, Jun; Kaida, Hayato; Kunou, Yukiko; Hirose, Yasumitsu; Abe, Toshi; Hayabuchi, Naofumi; Naito, Yoshiki; Okabe, Yoshinobu; Suga, Hideya; Kinoshita, Hisafumi

doi:10.2739/kurumemedj.57.91

Cited by 14 publications

(14 citation statements)

References 26 publications

(28 reference statements)

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“…These 2 internal weaknesses increased the risk of interpretation biases when building the 2 by 2 table "a priori." Moreover, in the meta-analysis by Kim et al, 5 10 studies did not report a clear definition of a BD-IPMN, 28,30,31,[34][35][36][37]46,47,49 including possible mixed-type IPMNs in the analysis and, consequently, increasing the rate of malignancy in the study population whereas, in the present study, all BD-IPMNs were clearly defined. Finally, in the present meta-analysis, all risk factors were considered, not only radiological parameters, as reported by Kim et al 5 ; the diagnostic performance of each parameter was evaluated using several classic biostatistical measurements of accuracy (DOR, sensitivity, specificity, AUC, positive and negative predictive values, or positive and negative likelihood ratios) whereas, in the previous metaanalyses, very few biostatistical measurements were adopted to explain the results.…”

Section: Discussioncontrasting

confidence: 63%

“…In addition, the quality assessment of the studies selected was carefully reported (Supplementary Table 2, http://links.lww.com/MPA/A500) whereas, on the contrary, in their meta-analysis, Kim et al 5 did not report the specific questions necessary to judge the risk of bias. In fact, only 6 studies specified whether the radiological parameters were interpreted by a blinded radiologist 26,31,36,41,43,48 and none of the studies were conducted with a blinded pathologist (Supplementary Figs. 2A, B, http://links.lww.com/MPA/A502).…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2016

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An "ideal risk factor" capable of recognizing all malignant branch-duct intraductal papillary mucinous neoplasms was not identified and some "dismal areas" remain. However, "high risk stigmata" were strongly related to malignancy, mainly enhancing mural nodules. Among the "worrisome features," duct dilatation and thickened/enhancing walls were underestimated, and their diagnostic performance was similar to those of "high risk stigmata." The carbohydrate antigen 19-9 serum level should be added to the Fukuoka algorithm because this value could help in carrying out correct management.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2016

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“…Several studies reported that ST and the malignant transformation of IPMN were significantly related . ST represents interstitial fibrosis and is caused by several microenvironmental factors .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported that ST and the malignant transformation of IPMN were significantly related. [31][32][33] ST represents interstitial fibrosis and is caused by several microenvironmental factors. [34][35][36] Shindo et al 37 found that podoplanin hyperexpression in the intramural regions of IPMN significantly affected cancer invasion and interstitial fibrosis and that the malignant transformation of IPMN correlated with ST. Based on these molecular pathological findings, we believe that although ST was an indirect finding, it was closely associated with the malignant transformation of IPMN.…”

Section: T He Present Study Investigated Whether St Mnmentioning

confidence: 99%

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

Iwaya

Hijioka²,

Mizuno³

et al. 2019

Digestive Endoscopy

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Background and Aim Septal thickness (ST) can predict a malignant branch‐duct (BD) and mixed‐type intraductal papillary mucinous neoplasm (IPMN) of the pancreas, but its cut‐off value has not been established. The aim of the present study was to determine the optimal ST cut‐off value to predict malignancy using endoscopic ultrasound (EUS). Methods We retrospectively identified 200 patients with IPMN, including 132 with BD‐ and mixed‐IPMN, who underwent surgical resection between 1989 and 2017. ST was defined as the septum or lesion wall with the maximum diameter in BD‐ and mixed‐IPMN. The possibility of ST as a malignant predictor was examined, as well as the diagnostic ability of ST combined with mural nodule (MN) height for malignant IPMN. Results Among the 132 IPMN patients, pathological diagnosis was benign in 81 (61.4%) and malignant in 51 (38.6%). Area under the curve for the diagnosis of malignancy using ST was 0.74 for pathological specimens, 0.70 for EUS and 0.56 for computed tomography. Multivariate analysis showed that the odds ratios for ST ≥2.5 mm and MN height ≥5 mm were 3.51 [95% confidence interval (CI), 1.55–7.97, P = 0.003] and 3.36 (95% CI, 1.52–7.45, P = 0.003), respectively. Conclusions Septal thickness was an independent predictive factor similar to MN height for malignant IPMN in a multivariate analysis. The ST on EUS appeared to be the thickness of a fibrotic septum associated with the malignant transformation of IPMN. An ST cut‐off value of 2.5 mm might provide an accurate prediction of malignant IPMN.

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“…The dilated ducts often contain profuse mucin. This tumor is also known as a mucin-producing pancreatic tumor, mucinous ductal ectasia, intraductal mucin-hypersecreting tumor or ductectatic mucinous cystic tumor [1][2]. Dilatation of the main pancreatic duct and side branches led to diagnosis of combined-type IPMN.…”

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confidence: 99%

MRCP Imaging of Intraductal Papillary-Mucinous Neoplasm of the Pancreas

Kantarcı

Bayraktutan

Yılmaz

et al. 2012

EAJM

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A 79-year-old man was admitted to the hospital with complaints of abdominal discomfort, jaundice and weight loss. His physical examination was unremarkable, but laboratory examinations revealed significant findings indicating steatorrhea and cholestasis. An ultrasound (US) study revealed marked dilatation of the main bile duct and bile duct as well as the associated branches, with no mass in the pancreatic head. A distended gallbladder was also observed on US. A magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of the main pancreatic duct and side branches with irregular mural thickening and several filling defects ( Figure A). These trends were also observed in 3-D volume rendering images ( Figure B). Secondary to these findings, the gallbladder was distended, and the bile ducts were dilated. No mass was identified in the pancreas. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), and histopathological examination of the biopsy revealed intraductal papillary-mucinous neoplasm (IPMN).Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by the presence of a mucin-producing tumor and cystic dilatation of the branches of the pancreatic duct in the uncinate process (branch duct type), diffuse or segmental dilatation of the main pancreatic duct (main duct type) or dilatation of the main ducts and branch ducts (combined type). The dilated ducts often contain profuse mucin. This tumor is also known as a mucin-producing pancreatic tumor, mucinous ductal ectasia, intraductal mucin-hypersecreting tumor or ductectatic mucinous cystic tumor [1][2]. Dilatation of the main pancreatic duct and side branches led to diagnosis of combined-type IPMN.MRCP is especially helpful for staging and as a road map to surgical and percutaneous intervention. Because the A B

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Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Cited by 14 publications

References 26 publications

Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms

Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms

Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched‐duct and mixed‐type intraductal papillary mucinous neoplasm of the pancreas

MRCP Imaging of Intraductal Papillary-Mucinous Neoplasm of the Pancreas

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