Branch Duct Type Intraductal Papillary Research Articles

Imaging Features for Predicting High-Grade Dysplasia or Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Systematic Review and Meta-Analysis.

The consensus guidelines for branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas are mostly based on imaging features. This study aimed to determine imaging features and their diagnostic accuracy for predicting high-grade dysplasia (HGD)/malignancy in BD-IPMN, including mixed type. The PubMed, Embase, and Cochrane databases were searched, and data were extracted from relevant studies. As the main diagnostic accuracy index, diagnostic odds ratios (DORs) of imaging features for diagnosing HGD/malignancy in BD-IPMNs were pooled using the random-effects model. A bivariate random-effects approach was used to construct summary receiver operating characteristic curves for sensitivity and specificity estimation. The pooled DOR was the highest for the enhanced solid component/mural nodule (MN) (DOR, 12.21; 95 % confidence interval [CI], 6.14-24.27), followed by a main pancreatic duct (MPD) diameter of 10mm or greater (DOR, 7.93; 95 % CI, 3.02-20.83), solid component (DOR, 4.85; 95 % CI, 2.49-9.42), lymphadenopathy (DOR, 4.84; 95 % CI, 1.11-21.06), MN (DOR, 4.48; 95 % CI, 3.15-6.39), an MPD diameter of 5mm or greater (DOR, 3.69; 95 % CI, 2.62-5.19), abrupt change in MPD caliber with distal pancreatic atrophy (DOR, 2.65; 95 % CI, 1.66-4.24), thickened/enhancing walls (DOR, 2.38; 95 % CI, 1.57-3.60), and cyst size of 3cm or larger (DOR, 1.98; 95 % CI, 1.48-2.64). The largest area under the curve (0.89 and 0.95, respectively) and high specificity (0.95 and 0.98, respectively) also were found for enhanced solid component/MN and an MPD diameter of 10 mm or greater, albeit with low sensitivity (0.38 and 0.14, respectively). The aforementioned imaging features could aid in predicting HGD/malignancy of BD-IPMN. Furthermore, enhanced solid component/MN and an MPD diameter of 10mm or greater were the most important predictors of HGD/malignancy in BD-IPMN and should be considered as indications for surgery.

ASO Author Reflections: Imaging Predictors of High-Grade Dysplasia or Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Systematic Review and Meta-Analysis.

ASO Author Reflections: Imaging Predictors of High-Grade Dysplasia or Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Systematic Review and Meta-Analysis.

Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis.

Simple SummaryCurrently, there are several guidelines that are widely used to establish the treatment strategy for branch duct type intraductal papillary mucinous neoplasms. Although there are some common grounds, there are discrepancies on which features they adopt, how much each feature is weighted, and how the features are combined. Furthermore, some of the features are based on lower level evidences or expert opinions. The aim of this meta-analysis was to investigate important clinical, radiological, and biochemical risk factors for malignancy and their impact as predictors. This study found symptom, size, cyst wall thickening, presence of mural nodule, change in main pancreatic duct caliber, lymphadenopathy, CA 19-9, and CEA as risk factors. Lymphadenopathy (odd ratio [OR]: 8.55), abrupt caliber change (OR: 7.41), and mural nodule (OR: 4.10) had the highest odd ratios. We expect the higher level evidences of this study to help shape better guidelines and reduce discrepancies among future guidelines.The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01–1.79), size ≥ 3 cm (OR 1.90, CI 1.51–2.40), cystic wall thickening (OR 2.53, CI 1.50–4.27), mural nodule (OR 4.10, CI 3.38–4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11–4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49–22.06), lymphadenopathy (OR 8.55, CI 3.25–22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55–6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60–2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.

Proposed Nomogram Predicting the Individual Risk of Malignancy in the Patients With Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas.

This study evaluated individual risks of malignancy and proposed a nomogram for predicting malignancy of branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) using the large database for IPMN. Although consensus guidelines list several malignancy predicting factors in patients with BD-IPMN, those variables have different predictability and individual quantitative prediction of malignancy risk is limited. Clinicopathological factors predictive of malignancy were retrospectively analyzed in 2525 patients with biopsy proven BD-IPMN at 22 tertiary hospitals in Korea and Japan. The patients with main duct dilatation >10 mm and inaccurate information were excluded. The study cohort consisted of 2258 patients. Malignant IPMNs were defined as those with high grade dysplasia and associated invasive carcinoma. Of 2258 patients, 986 (43.7%) had low, 443 (19.6%) had intermediate, 398 (17.6%) had high grade dysplasia, and 431 (19.1%) had invasive carcinoma. To construct and validate the nomogram, patients were randomly allocated into training and validation sets, with fixed ratios of benign and malignant lesions. Multiple logistic regression analysis resulted in five variables (cyst size, duct dilatation, mural nodule, serum CA19-9, and CEA) being selected to construct the nomogram. In the validation set, this nomogram showed excellent discrimination power through a 1000 times bootstrapped calibration test. A nomogram predicting malignancy in patients with BD-IPMN was constructed using a logistic regression model. This nomogram may be useful in identifying patients at risk of malignancy and for selecting optimal treatment methods. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.

Sa1510 Impact of Positive MUC 1 Expression in Cell Block Cytology Specimen for the Progression of Branch-Duct Type Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

Sa1510 Impact of Positive MUC 1 Expression in Cell Block Cytology Specimen for the Progression of Branch-Duct Type Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

Su1358 Predictors of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas Without Mural Nodule on CT: A Nationwide Multicenter Study

Su1358 Predictors of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas Without Mural Nodule on CT: A Nationwide Multicenter Study

膵頭部と尾部に発生した多発分枝型膵管内乳頭粘液性腫瘍に対してmiddle-segment preserving pancreatectomyを施行した1例

膵頭部と尾部に発生した多発分枝型膵管内乳頭粘液性腫瘍に対してmiddle-segment preserving pancreatectomyを施行した1例

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

Su1471 Clinical Observation Is Possible for Branch Duct Type Intraductal Papillary Mucinous Neoplasms With Mural Nodules ≤6mm

Introduction: The presence of mural nodule (MN) is an important factor for the management of branch duct type intraductal papillary mucinous neoplasm (BD-IPMN). International consensus guidelines 2012 recommend clinical follow-up to BD-IPMN without MNs. However, it is not clear whether BD-IPMNs with MNs need surgical treatment regardless of the height of MNs. Aim: To compare the pathological and follow-up outcomes between BDIPMNs with MNs ≤6mm in height (MN+) and those without MNs (MN-). Methods: The patients who were diagnosed as BD-IPMNs with MNs ≤6mm or without MNs since April 2004 to December 2013 were retrospectively analyzed. Inclusion criteria were the obtaining of contrast enhanced CT and EUS at initial diagnosis, and surgical resection in our center or follow-up with annual/semi-annual CT/MRCP. The cyst size and main pancreatic duct (MPD) diameter were measured by CT/MRCP, while MN height was measured by EUS. Tumor progression during follow-up was defined as follows; increased cyst size ≥10mm; increased MPD diameter ≥10mm; new development of MN or increased MN height ≥2mm. Evaluation points: 1) pathological diagnosis of resected BD-IPMN, 2) follow-up outcomes Results: Among 656 patients of BD-IPMNs diagnosed in our center, MN height was evaluated as less than or equal to 6mm in 511(78%; MN+ 50, MN352). After initial diagnosis, 17(3%; MN+ 8, MN9) of them underwent immediate resection and 385(75%; MN+ 42, MN343) of them received regular follow-up, who were eligible for this analysis. The median cyst size and MPD diameter were 20(10-70) mm and 3(2-12) mm, respectively. The median height of MNs in MN+ were 3(1-6) mm. 1) The pathological diagnosis of the patients with MNwere all low/intermediate-grade dysplasia (LID), while those of the patients with MN+ were LID in 5, high-grade dysplasia (HD) in 2, and invasive carcinoma (IC) in 1. There were no significant differences in pathological diagnosis between MN+ and MN(p=0.17, chi-square test). 2) During a median follow-up period of 3.4(0.5-10.6) years, 49(13%; MN+ 9, MN40) patients exhibited tumor progression. The 5-years cumulative tumor progression rate was higher in MN+ than those in MN(MN+ 19% vs MN9%; p<0.01, Log-rank test). Among 49 patients with tumor progression, 11(22%; MN+ 4, MN7) patients underwent surgical resection, whose pathological diagnosis were LID in 6(MN+ 2, MN4), HD in 3(MN+ 1, MN2), and IC with minimal invasion in 2(MN+ 1, MN1). The other 38 patients continued to be followed during a median period of 0.6(0.0-4.2) years. Meanwhile, concomitant pancreatic ductal adenocarcinoma (PDAC) was appeared in 9(2%; MN+ 1, MN8) patients. Conclusion: Although tumor progression rate was higher, BD-IPMN with MNs ≤6mm in height on EUS could be managed conservatively. However, careful attention should be paid to the development of PDAC during follow-up.

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

We evaluated the accuracy of a new endoscopic ultrasonography (EUS) scoring system to predict malignancy in branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs). We performed a retrospective multicenter study of patients who underwent EUS within 3 months before surgery and were diagnosed as having BD-IPMNs by postoperative pathologies at 8 hospitals in Korea from August 2002 to December 2011. To predict the malignancy, we applied the EUS scoring system consisting of pancreatic cyst size, height of mural nodules, main duct dilatation, septal thickening, and patulous orifice. We evaluated the diagnostic accuracy of the new EUS scoring system and compared it with previous individual risk factors. Eighty-four patients (male-to-female ratio, 55:29; mean [SD] age, 64.7 [7.1] years) had 68 benign BD-IPMNs and 16 malignant intraductal papillary mucinous neoplasms. The EUS scoring system showed 75.0% sensitivity and 94.1% specificity at 7 points. This system (area under the curve, 0.939; 95% confidence interval, 0.884-0.994) resulted in a more accurate prediction than the previous known other factors including Sendai criteria, dilatation of ducts, size of the cyst, and presence of septal thickening and mural nodules. The EUS scoring system predicted BD-IPMN malignancy more accurately than the Sendai criteria and individual risk factors.

Mo1432 Smart Atlas for Supporting the Interpretation of Needle-Based Confocal LASER Endomicroscopy (nCLE) of Pancreatic Cysts: First Classification Results of a Computer-Aided Diagnosis Software Based on Image Recognition

nCLE enables microscopic imaging of pancreatic cysts, in vivo and in real time, during an EUS-FNA procedure. Differentiating branch duct-type Intraductal Papillary Mucinous Neoplasm (IPMN) and Serous Cystadenoma (SCA) of the pancreas can be difficult, especially in case of a solitary lesion without clear communication with the pancreatic duct. Recent studies (Konda et al., Endoscopy 2013; Napoléon et al., DDW 2013) have identified reliable nCLE descriptive features (superficial vascular network in SCA; finger-like projections in IPMN), allowing endoscopists to discriminate between SCA and IPMN.

Imaging Features to Distinguish Malignant and Benign Branch-Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

To systematically determine the imaging findings for distinguishing malignant and benign branch-duct type intraductal papillary mucinous neoplasms (BD-IPMNs), including mixed type, and their diagnostic value through meta-analysis of published studies. Management of BD-IPMNs, including mixed type, largely relies on imaging findings. The current knowledge on imaging findings to distinguish malignant and benign BD-IPMNs has weak evidence and is mostly from scattered individual retrospective studies. Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies where findings of computed tomography, magnetic resonance imaging, and endoscopic ultrasonography of BD-IPMNs with or without main pancreatic duct (MPD) dilatation were correlated with surgical/pathological findings. Review of 1128 article candidates, including full-text review of 102 articles, identified 23 eligible articles with a total of 1373 patients for meta-analysis. Dichotomous data regarding distinction between malignant and benign BD-IPMNs were pooled using random effects model to obtain the diagnostic odds ratios (DORs) and their 95% confidence intervals (CIs) of various individual imaging findings for diagnosing malignant BD-IPMN. Presence of mural nodules revealed the highest pooled DOR (95% CI) of 6.0 (4.1-8.8) followed by MPD dilatation [3.4 (2.3-5.2)], thick septum/wall [unadjusted, 3.3 (1.5-6.9); publication bias-adjusted, 2.3 (0.9-5.5)], and cyst size greater than 3 cm [2.3 (1.5-3.5)]. Multilocularity and multiplicity of the cystic lesions did not reveal statistically significant association with malignancy. Presence of mural nodules should be regarded highly suspicious for malignancy warranting a surgical excision whereas cyst size greater than 3 cm, MPD dilatation (5-9 mm), or thick septum/wall may better be managed by careful observation and/or further evaluation.

A case of branch duct type intraductal papillary neoplasm of the bile duct treated by open surgery after 11 years of follow-up

The intraductal papillary neoplasm of the bile duct (IPNB) is a novel disease concept that was recently classified as a biliary cystic tumor by the revised World Health Organization classification. This is the case report of a 70-year-old female patient who experienced repeated episodes of obstructive jaundice and cholangitis since 2000, attributed to a mucus-producing hepatic tumor. Surgery was advised due to the repeated episodes; however, the patient refused. In May, 2011, the patient developed jaundice and fever and was treated with antibiotics. Since there was no improvement, the patient was admitted to the Tokyo Rosai Hospital. Abdominal computed tomography (CT) revealed a 50-mm cystic mass with an internal septum in the left hepatic lobe. Although the tumor size had remained almost unchanged compared to the initial CT scan performed in 2000, intra- and extra-hepatic bile duct dilation was more prominent on the second CT scan. Following admission, endoscopic retrograde cholangiopancreatography was performed and revealed an expanded papilla of Vater due to a mucous plug. A balloon catheter was inserted into the bile duct to remove the mucous plug, resulting in the drainage of copious amounts of mucus and infected bile. The patient finally consented to surgery and left hepatic lobectomy was performed. Consequently, the diagnosis of low-grade IPNB was made. Branch duct type IPNB, which is characterized by imaging appearance of a cystic mass and slow progression, is attracting increasing attention. In the present case, a cystic mass was identified in the left hepatic lobe, with no significant change in size after 11 years of follow-up, leading to the diagnosis of branch duct type IPNB. Considering the fact that IPNB is usually treated surgically at the time of diagnosis, the present case, due to the long-term follow-up, provides valuable insight into the natural history of the tumor.

Predictive Factors for the Increase in Size of Branch Duct-type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Retrospective Cohort Study with a 6-year Follow-Up

Predictive Factors for the Increase in Size of Branch Duct-type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Retrospective Cohort Study with a 6-year Follow-Up

Malignant Transformation of Branch Duct–Type Intraductal Papillary Mucinous Neoplasms of the Pancreas Based on Contrast-Enhanced Endoscopic Ultrasonography Morphological Changes

The natural history of branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas remains unclear. We conducted a retrospective long-term follow-up study for malignant transformation (MT) of BD-IPMNs focusing on morphological changes. The subjects consisted of 142 patients who underwent contrast-enhanced endoscopic ultrasonography for initial diagnosis from January 2001 with more than 12 months of follow-up. The MT rate, including the co-occurrence of invasive ductal cancer, was evaluated by univariate and multivariate analysis. In addition, on the basis of morphological changes in patients who underwent surgery, the predictive factors for malignant IPMNs were evaluated. Median follow-up term was 42.5 months (range, 12-105 months). Thirty patients who exhibited morphological changes underwent surgery. Malignant transformation occurred in 9 patients (6.3%), and 5-year MT rate was 10.7%. The co-occurrence of invasive ductal cancer was seen in 5 patients. Multivariate analysis showed that the existence of mural nodules at initial diagnosis and involvement of main pancreatic duct were significant predictors of MT of BD-IPMN. Malignant transformation of BD-IPMN is not rare. The observation of morphological changes of main pancreatic duct and nodules, mainly on contrast-enhanced endoscopic ultrasonography, is practical and useful for predicting MT of BD-IPMN itself.

Mo1196 Risk Factors for the Development of Pancreatic Ductal Adenocarcinoma During the Follow-up of Branch Duct-Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Background: Branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) is a risk factor for pancreatic ductal adenocarcinoma (PDAC), but the groups at high risk for developing PDAC during the follow-up period of BD-IPMN are not clear. Objectives: To identify the risk factors for PDAC development during the follow-up period of BD-IPMN. Subjects and Methods: We investigated 230 patients undergoing follow-up of BD-IPMN; the median follow-up period was 56.9 months, and the range was 3-276 months. Among these patients, 10 developed pancreatic cancer (PDAC, 7; intraductal papillary mucinous carcinoma [IPMC], 3). The 230 patients were divided into 2 groups: PDAC group, which included 7 patients; and non-PDAC group, which included 223 patients. The PDAC and non-PDAC groups were compared with respect to the following factors: sex; age; follow-up period; number of BD-IPMNs; size of BD-IPMNs; diameter of the main pancreatic duct (MPD); size of mural nodules; family history of pancreatic cancer (within the second degree of relationship); family history of digestive organ cancer, except pancreatic cancer (within the second degree of relationship); diabetes mellitus; adiposis (body mass index [BMI] ≥ 30 kg/m2); chronic pancreatitis; and history of smoking. A chi-square test and a t test were used for univariate analysis, and logistic regression was used for multivariate analysis. Results:Univariate analysis showed that adiposis (p = 0.016), chronic pancreatitis (p = 0.038), and a family history of pancreatic cancer (p = 0.006) were the factors significantly associated with PDAC development. Multivariate analysis of these 3 factors showed that adiposis (p = 0.000, odds ratio = 60.93, 95% confidence interval [CI] = 6.18-599.92), chronic pancreatitis (p = 0.023, odds ratio = 13.0, 95% CI = 1.42-119.35), and a family history of pancreatic cancer (p = 0.003, odds ratio = 21.1, 95% CI = 2.87-156.49) were independently associated with PDAC development. Conclusions: Our results showed that adiposis (BMI ≥ 30 kg/ m2), chronic pancreatitis, and a family history of pancreatic cancer (within the second degree of relationship) were risk factors for PDAC development during the follow-up period of BD-IPMN patients.

The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Identification of predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms (IPMN). Main duct type IPMN has been recommended for resection. However, the indications for resection of the branch duct type IPMN have been controversial. We retrospectively analyzed the clinicopathological factors of 134 patients undergoing resection for branch duct type IPMN, excluding main duct type IPMN, to identify predictors of the malignant behavior of this neoplasm. The cutoff values of tumor size, main pancreatic duct (MPD) size, mural nodule size, and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained during preoperative endoscopic retrograde pancreatography (ERP) were analyzed using receiver-operator characteristic curves. We found 7 significant predictors for malignancy in the branch duct type IPMN in a univariate analysis; jaundice, tumor occupying the pancreatic head, MPD size >5 mm, mural nodule size >5 mm, serum carbohydrate antigen (CA)19-9 level, positive cytology in the pancreatic juice, and CEA level in the pancreatic juice >30 ng/mL. In a multivariate analysis, a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL were independent factors associated with malignancy. The positive predictive value of a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL was 100%, and the negative predictive value was 96.3%. We identified 2 useful predictive factors for malignancy in branch duct type IPMN; a mural nodule size >5 mm and a CEA level in the pancreatic juice obtained by preoperative ERP >30 ng/mL.

Comparison of Efficacy of Enucleation and Pancreaticoduodenectomy for Small (&lt;3 cm) Branch Duct Type Intraductal Papillary Mucinous Neoplasm Located at the Head of Pancreas and the Uncinate Process

PurposeAccurate indications and the extent of surgery for branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debatable. In particular, small tumor is located at the head portion of pancreas presents a dilemma. The purpose of this study is to compare the efficacy of enucleation (EN) with that of pancreaticoduodenectomy (PD) in patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process.Materials and MethodsAmong 155 patients who underwent pancreatic surgery due to pancreatic cystic tumors between January 2000 and December 2007 at Yonsei University Health System in Seoul, Korea, 14 patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process were included in this study. Ten patients underwent PD, and four patients underwent EN. We compared short term surgical outcomes between the two groups. Correlation of the variables was analyzed using Mann-Whitney test and Fisher's exact test (SPSS Window 12.0). p-values less than 0.05 were considered significant.ResultsThe average age was 62.21 years (±6.71 years) and consisted of 8 men and 6 women. The mean operation time and blood loss were significantly lower in EN group. There were no significant differences in other surgical morbidities.ConclusionThe result suggests that enucleation for small branch duct IPMN located at the head of pancreas or uncinate process is feasible and as safe as PD, despite a high rate of minor complications.

Use of Multidetector-Row Computed Tomography to Evaluate Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: Influence on Surgical Decision-Making

The purpose of this study was to evaluate factors predictive of the malignant grade associated with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) using multidetectorrow computed tomography (MDCT). We reviewed the morphological features of 26 BDIPMNs using MDCT. Tumor size, caliber of the main pancreatic duct, number of mural nodules, diameter of the largest mural nodule and volume of the largest mural nodule were assessed and correlated with the pathological findings. By multiple- and single-regression analyses and Mann-Whitney U test, significant differences in the caliber of the main pancreatic duct and number of mural nodules were observed between adenoma and non-invasive carcinoma and in the number of mural nodules between adenoma and invasive carcinoma. No significant differences were observed between non-invasive carcinoma and invasive carcinoma. Based on the differential diagnostic criterion of 1 or more mural nodules for distinguishing adenoma from non-invasive carcinoma and invasive carcinoma, the sensitivities were 60% and 100%, respectively, and the specificity was 93% for both. Although it was impossible to distinguish non-invasive carcinoma from invasive carcinoma, MDCT was reliable for distinguishing adenoma from non-invasive carcinoma and invasive carcinoma.

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 ± 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.