Prediction of malignancy in main duct or mixed-type intraductal papillary mucinous neoplasms of the pancreas

Hye Sol Jung, Youngmin Han, Jae Seung Kang, Heeju Sohn, Mirang Lee, Kyung Bun Lee, Hongbeom Kim, Wooil Kwon, Jin Young Jang

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background/Purpose: Surgical indications of main duct-involved intraductal papillary mucinous neoplasm (IPMN), especially for main pancreatic duct (MPD) of 5-9 mm, remain controversial. We aimed to predict malignancy risk of main duct-involved IPMN. Methods: Total 258 patients with main duct-involved IPMN between 2000 and 2017 in our institute were retrospectively analyzed. Main duct IPMN was classified into segmental and diffuse-type by dilated MPD pattern. Clinicopathologic features and predictive factors for malignancy were analyzed. Results: Among 258 patients, 47 and 211 had pure main duct (segmental: 27, diffuse type: 20) and mixed type, respectively. Malignant IPMN presented higher in main duct type (66.0%) compared to mixed type (46.9%). The diffuse type (72.2%) had more invasive carcinoma than the segmental type (40.7%). Invasive IPMN risk increased proportionally to the MPD diameter (5 ≤ MPD <10 mm vs 10 ≤ MPD < 15 mm vs MPD ≥ 15 mm; 23.4% vs 40.0% vs 48.6%). Symptoms, elevated serum carbohydrate antigen, MPD ≥10 mm, mural nodule, thickened wall, and distal atrophy were independent predictive factors for malignancy. Patients with MPD of 5-9 mm with at least one predictive factor had 35.0% of malignancy risk. Conclusions: The invasive IPMN risk was different according to the dilated main duct pattern. Patients with main duct type, diffuse type, MPD ≥10 mm, and MPD 5-9 mm with at least one predictive factor should be candidates for immediate surgery.

Original languageEnglish
Pages (from-to)1014-1024
Number of pages11
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume29
Issue number9
DOIs
StatePublished - Sep 2022

Keywords

  • IPMN
  • main duct
  • malignancy
  • predictive factors
  • prognosis

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