Predictors of Malignancy in “Pure” Branch-Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas without Enhancing Mural Nodules on CT Imaging: A Nationwide Multicenter Study.
- Author:
Tae Hyeon KIM
1
;
Young Sik WOO
;
Hyung Ku CHON
;
Jin Hyeok HWANG
;
Kyo Sang YOO
;
Woo Jin LEE
;
Kwang Hyuck LEE
;
Jong Kyun LEE
;
Seok Ho DONG
;
Chang Hwan PARK
;
Eun Taek PARK
;
Jong Ho MOON
;
Ho Gak KIM
;
Kwang Bum CHO
;
Hong Ja KIM
;
Seung Ok LEE
;
Young Koog CHEON
;
Jeong Mi LEE
;
Jin Woo PARK
;
Myung Hwan KIM
Author Information
- Publication Type:Multicenter Study ; Original Article
- Keywords: Branch duct-IPMN; Neoplasms; Multicenter study; Mural nodule
- MeSH: Christianity; Humans; Korea; Mucins*; Multivariate Analysis; Pancreas*; Pancreatic Ducts; Retrospective Studies; Risk Factors; Tertiary Care Centers; Ultrasonography
- From:Gut and Liver 2018;12(5):583-590
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. METHODS: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. RESULTS: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. CONCLUSIONS: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
