Su1495 Proteomic Studies on Aspirates From Cystic Neoplasms of the Pancreas Provide New Clues to Their Molecular Background and Reveal Novel Biomarker Candidates

Abstract

G A A b st ra ct s papillary mucinous neoplasm and to assess the impact on the diagnosis of IPMN. Methods: We retrospectively analysed the clinicopathological factors of 177 patients (114 men, median age 63 yr) undergoing resection for branch duct type IPMNs at 15 tertiary hospitals in korea that had the diameter of main pancreatic duct less than 5 mm for identifying malignant predictors of this neoplasm. For the analysis, Br-IPMN with adenoma (n=72), borderline neoplasm (n=66) were grouped as benign and Br-IPMNs with carcinoma in situ(n=10), and invasive carcinoma (n=29) as malignant. Malignant IPMNs were defined as those with noninvasive (n=10 noninvasive carcinoma, and 29 invasive carcinoma). and invasive IPMN. Results: Among 177 patients with branch duct IPMN, we found significant predictors for malignancy in these patients in a univariate analysis; cyst size > 3cm, presence of a mural nodule in the cyst at abdominal CT, the history of acute pancreatitis, serum CA19-9. In a multivariate analysis among 177 patients, a mural nodule on CT imaging, cyst size>3cm, and serum CA19-9 were independent factors associated with malignancy. In patients (n= 110) who had endoscopic ultrasonography (EUS), cyst size > 3cm (odd ratio=10.6, CI= 2.812-40.199) and mural nodule larger than 5mm (odd ratio=14.9, CI=4.027-55.418) on EUS imaging is strongly associated with Malignant Br-IPMNs (p 5mm used instead of definitive mural nodule on EUS imaging in the 2012 international consensus guideline for IPMNs, the sensitivity and specificity was 84% and 85%. Conclusions: We identified useful predictive factors for malignancy in pure branch duct IPMN ; the presence of mural nodule and cyst size > 3cm on abdominal CT imaging, and the mural nodule larger than 5 mm on EUS imaging. In the worrisome features of 2012 international guideline for surgical indication of IPMNs, using the mural nodule larger than 5 mm instead of definitive mural nodule on EUS imaging may be reasonable.