Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery

Tae Hyeon Kim; Tae Jun Song; Seung Ok Lee; Chang Hwan Park; Jong Ho Moon; Gyu Young Pih; Dong Wook Oh; Sang Myoung Woo; Yun Jung Yang; Myung Hwan Kim

doi:10.1016/j.pan.2019.09.010

Main duct and mixed type intraductal papillary mucinous neoplasms without enhancing mural nodules: Duct diameter of less than 10 mm and segmental dilatation of main pancreatic duct are findings support surveillance rather than immediate surgery

Pancreatology. 2019 Dec;19(8):1054-1060. doi: 10.1016/j.pan.2019.09.010. Epub 2019 Sep 24.

Authors

Affiliations

¹ Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, South Korea.
² Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
³ Chonbuk National University Medical School, Jeonju, South Korea.
⁴ Department of Internal Medicine, Chonnam University College of Medicine, Kwangju, South Korea.
⁵ Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, South Korea.
⁶ Pancreatobiliary Cancer Clinic, Center for Liver Cancer, National Cancer Center, Goyang, South Korea.
⁷ Institute for Integrative Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea.
⁸ Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: mhkim@amc.seoul.kr.

PMID: 31611130
DOI: 10.1016/j.pan.2019.09.010

Abstract

Objective: The guidelines for pancreatic intraductal papillary mucinous neoplasms (IPMNs) recommend surgical resection of all main-duct (MD) and mixed-type IPMNs in surgically fit patients. We conducted this study to identify the rates of high-grade dysplasia (HGD) and invasive carcinoma according to the morphological features of the main pancreatic duct (MPD) in patients with MD and mixed IPMN.

Methods: We performed a retrospective study of 259 patients with histologically proven MD and mixed-type IPMNs who underwent surgery at six academic institutions.

Results: The rate of HGD and invasive carcinoma was 11.1% (24/216) in patients without enhancing mural nodules (MNs) and 69.8% (30/43) in patients with MNs. Multivariate analysis showed that MPD diameter of ≥10 mm [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.155-5.505; P = 0.02], diffuse MPD dilatation (OR, 3.2; 95% CI, 1.152-8.998; P = 0.02), and presence of enhancing MNs in MPD (OR, 9.6; 95% CI, 3.928-23.833, P < 0.0001) were significant predictors of HGD and invasive carcinoma. Of the 216 patients without enhancing MNs, 79 patients (36.6%) having both segmental MPD dilatation and MPD diameter of <10 mm showed significantly lower rates of HGD and invasive carcinoma (3/79, 3.8%) than patients having both diffuse MPD dilatation and MPD diameter ≥10 mm (9/36, 25%, P = 0.001).

Conclusions: MD and mixed-type IPMNs having segmental MPD dilatation with MPD dilation <10 mm and no enhancing MNs on imaging showed a significantly lower rate of HGD and invasive carcinoma, and watchful follow-up instead of immediate surgical resection might be possible in these patients.

Keywords: Main duct intraductal papillary mucinous neoplasms; Mixed type intraductal papillary mucinous neoplasms; Mural nodule; Pancreatic cancer.

MeSH terms

Adenocarcinoma, Mucinous / pathology*
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal / pathology*
Carcinoma, Papillary / pathology*
Female
Humans
Male
Middle Aged
Odds Ratio
Pancreatic Ducts / pathology*
Pancreatic Neoplasms / pathology*
Retrospective Studies
Risk Factors