TY - JOUR
T1 - Intraductal papillary mucinous neoplasms
T2 - Predictors of malignant and invasive pathology
AU - Schmidt, C. Max
AU - White, Patrick B.
AU - Waters, Joshua A.
AU - Yiannoutsos, Constantin T.
AU - Cummings, Oscar W.
AU - Baker, Marshall
AU - Howard, Thomas J.
AU - Zyromski, Nicholas J.
AU - Nakeeb, Atilla
AU - DeWitt, John M.
AU - Akisik, Fatih M.
AU - Sherman, Stuart
AU - Pitt, Henry A.
AU - Lillemoe, Keith D.
PY - 2007/10
Y1 - 2007/10
N2 - OBJECTIVE: Determine whether size and other preoperative parameters predict malignant or invasive intraductal papillary mucinous neoplasia (IPMN). SUMMARY BACKGROUND DATA: From 1991 to 2006, 150 patients underwent 156 operations for IPMN. METHODS: Prospectively collected, retrospective review of a single academic institution's experience. All preoperative parameters including a detailed radiologic-based classification of IPMN type, location, distribution, size, number, cytology, and mural nodularity were correlated with IPMN pathology. RESULTS: Malignant IPMN was present in 32% of cases, whereas 19% of cases were invasive. IPMN type and main pancreatic duct diameter were significant predictors of malignant IPMN (P <0.001). Side-branch lesion number was negatively associated with invasive IPMN (P = 0.03). Side-branch size, location, and distribution did not predict IPMN pathology. The presence of mural nodules was associated with malignant and invasive IPMN (P <0.001; P <0.02). Atypical cytopathology was significantly associated with malignant and invasive IPMN (P <0.001; P <0.001). Multivariate analysis demonstrated mural nodularity and atypical cytopathology were predictive of malignancy and/or invasion in branch-type IPMN. CONCLUSIONS: To lower the rate of invasive pathology, surgery should be recommended for fit patients with main-duct IPMN and for branch-duct IPMN with mural nodularity or positive cytology irrespective of location, distribution, or size.
AB - OBJECTIVE: Determine whether size and other preoperative parameters predict malignant or invasive intraductal papillary mucinous neoplasia (IPMN). SUMMARY BACKGROUND DATA: From 1991 to 2006, 150 patients underwent 156 operations for IPMN. METHODS: Prospectively collected, retrospective review of a single academic institution's experience. All preoperative parameters including a detailed radiologic-based classification of IPMN type, location, distribution, size, number, cytology, and mural nodularity were correlated with IPMN pathology. RESULTS: Malignant IPMN was present in 32% of cases, whereas 19% of cases were invasive. IPMN type and main pancreatic duct diameter were significant predictors of malignant IPMN (P <0.001). Side-branch lesion number was negatively associated with invasive IPMN (P = 0.03). Side-branch size, location, and distribution did not predict IPMN pathology. The presence of mural nodules was associated with malignant and invasive IPMN (P <0.001; P <0.02). Atypical cytopathology was significantly associated with malignant and invasive IPMN (P <0.001; P <0.001). Multivariate analysis demonstrated mural nodularity and atypical cytopathology were predictive of malignancy and/or invasion in branch-type IPMN. CONCLUSIONS: To lower the rate of invasive pathology, surgery should be recommended for fit patients with main-duct IPMN and for branch-duct IPMN with mural nodularity or positive cytology irrespective of location, distribution, or size.
UR - http://www.scopus.com/inward/record.url?scp=34748884944&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34748884944&partnerID=8YFLogxK
U2 - 10.1097/SLA.0b013e318155a9e5
DO - 10.1097/SLA.0b013e318155a9e5
M3 - Article
C2 - 17893501
VL - 246
SP - 644
EP - 651
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 4
ER -