Management of branch-duct intraductal papillary mucinous neoplasms: a large single-center study to assess predictors of malignancy and long-term outcomes

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• 作者：Wiriyaporn Ridtitid ; MD¹ ; ² ; John M. DeWitt ; MD¹ ; C. Max Schmidt ; MD ; PhD¹ ; Alexandra Roch ; MD¹ ; Jennifer Schaffter Stuart ; BS¹ ; Stuart Sherman ; MD¹ ; Mohammad A. Al-Haddad ; MD ; MSc ; FASGE³ ;
• 关键词：AGA ; American Gastroenterological Association Institute ; BD-IPMN ; branch-duct intraductal papillary mucinous neoplasm ; HRS ; high-risk stigmata ; ICG ; International Consensus Guidelines ; MPD ; main pancreatic duct ; MRI ; magnetic resonance imaging ; WF ; worrisome feature
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：84
• 期：3
• 页码：436-445
• 全文大小：420 K

文摘

Management of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging. We determined factors associated with malignancy in BD-IPMNs and long-term outcomes.

Methods

This retrospective cohort study included all patients with established BD-IPMNs by the International Consensus Guidelines (ICG) 2012 and/or pathologically confirmed BD-IPMNs in a tertiary care referral center between 2001 and 2013. Main outcome measures were the association between high-risk stigmata (HRS)/worrisome features (WFs) of the ICG 2012 and malignant BD-IPMNs, performance characteristics of EUS-FNA for the diagnosis of malignant BD-IPMNs, and recurrence and long-term outcomes of BD-IPMN patients undergoing surgery or imaging surveillance.

Results

Of 364 BD-IPMN patients, 229 underwent imaging surveillance and 135 underwent surgery. Among the 135 resected BD-IPMNs, HRS/WFs on CT/magnetic resonance imaging (MRI) were similar between the benign and malignant groups, but main pancreatic duct (MPD) dilation (5-9 mm) was more frequently identified in malignant lesions. On EUS-FNA, mural nodules, MPD features suspicious for involvement, and suspicious/positive malignant cytology were more frequently detected in the malignant group with a sensitivity, specificity, and accuracy of 33%, 94%, and 86%; 42%, 91%, and 83%; and 33% 91%, and 82%, respectively. Mural nodules identified by EUS were missed by CT/MRI in 28% in the malignant group. Patients with malignant lesions had a higher risk of any IPMN recurrence during a mean follow-up period of 131 months (P = .01).

Conclusions

Among HRS and WFs of the ICG 2012, an MPD size of 5 to 9 mm on CT/MRI was associated with malignant BD-IPMNs. EUS features including mural nodules, MPD features suspicious for involvement, and suspicious/malignant cytology were accurate and highly specific for malignant BD-IPMNs. Our study highlights the incremental value of EUS-FNA over imaging in identifying malignant BD-IPMNs, particularly in patients without WFs and those with smaller cysts. Benign IPMN recurrence was observed in some patients up to 8 years after resection.