Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms

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• 作者：Khaled Abdeljawad ; MD¹ ; Krishna C. Vemulapalli ; MBBS ; MPH¹ ; ² ; C. Max Schmidt ; MD ; PhD³ ; John Dewitt ; MD ; FASGE¹ ; ² ; Stuart Sherman ; MD ; FASGE¹ ; ² ; Thomas F. Imperiale ; MD¹ ; ² ; Mohammad Al-Haddad ; MBBS ; MSc ; FASGE¹ ; ² ;
• 关键词：AR ; absolute risk ; CI ; confidence interval ; IPMN ; intraductal papillary mucinous neoplasm ; MD-IPMN ; main duct intraductal papillary mucinous neoplasm ; MPD ; main pancreatic duct ; ROC ; receiver operating characteristic
• 刊名：Gastrointestinal Endoscopy
• 出版年：April, 2014
• 年：2014
• 卷：79
• 期：4
• 页码：623-629
• 全文大小：837 K

文摘

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Background

Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear.

Objective

To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size.

Design

Single-center retrospective study of prospectively collected data.

Settings

Tertiary referral center.

Patients and Interventions

Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed.

Main outcome measurements

Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions.

Results

Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8聽mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI, .72-.94). MPD size greater than 8聽mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9).

Limitations

Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection.

Conclusion

Asymptomatic MD-IPMN patients with a duct size of no more than 8聽mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.