Abdominal ultrasound in the characterization of branch-duct intraductal papillary mucinous neoplasms: A new tool for surveillance of low-risk patients?

Marco Ferronato; Chiara Elide Lizzio; Dante Berardinelli; Desy Marini; Eleonora Elia; Lorenzo Andreetto; Alice Trentini; Maria Chiara Potenza; Carla Serra; Elena Mazzotta; Claudio Ricci; Riccardo Casadei; Marina Migliori

doi:10.1016/j.dld.2023.11.010

Abdominal ultrasound in the characterization of branch-duct intraductal papillary mucinous neoplasms: A new tool for surveillance of low-risk patients?

Dig Liver Dis. 2023 Dec 1:S1590-8658(23)01029-0. doi: 10.1016/j.dld.2023.11.010. Online ahead of print.

Affiliations

¹ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy. Electronic address: marco.ferronato@studio.unibo.it.
² IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy.
³ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Interventional Utrasound Unit, Italy.
⁴ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pancreas and Endocrine Surgery Unit, Italy.

PMID: 38042636
DOI: 10.1016/j.dld.2023.11.010

Abstract

Background: Magnetic resonance imaging (MRI) is regarded as gold-standard for intraductal papillary mucinous neoplasms (IPMNs) follow-up. Given the low risk of transformation and the increasing population under surveillance, there is growing interest in identifying optimal follow-up strategies.

Aim: To evaluate reliability of abdominal ultrasound (US) for characterization of low-risk IPMN, compared to MRI.

Methods: Prospective monocentric study among 79 consecutive patients with a suspected BD-IPMN on US. Each patient underwent confirmatory MRI. We evaluated Cohen's kappa statistic and concordance rate (CR) between MRI and US.

Results: Of 79 suspected IPMNs on US, MRI confirmed 71 BD-IPMNs. There was high agreement for cyst location and number (CR and kappa of 77.5 % and 81.7 % and 0.66±0.08 and 0.62±0.11 respectively). We found high agreement for cyst size (CR=96.5 %, kappa=0.93±0.05) and main pancreatic duct (MPD) dilatation (CR=100 %, kappa=1). There was a good agreement for thickened septa (CR=80.3 %, kappa=0.38±0.12). US seems inferior to MRI for the identification of mural nodules < 5 mm (CR=97.2 %, kappa=0).

Conclusions: In a cohort of low-risk BD-IPMN, US presented high agreement rate with MRI regarding location, number, and size. There was a good agreement for MPD dilatation and thickened septa, while US underperform for detection of mural nodules < 5 mm.

Keywords: Echography; Follow-up; IPMN; Trans-abdominal; US; Worrisome feature.