Intraductal papillary mucinous neoplasms of the pancreas

Differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules

Eizaburo Ohno, Yoshiki Hirooka, Akihiro Itoh, Masatoshi Ishigami, Yoshiaki Katano, Naoki Omiya, Yasumasa Niwa, Hidemi Goto

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

BACKGROUND AND AIM: Intraductal papillary mucinous neoplasms (IPMNs) have a wide pathologic spectrum and it is difficult to differentiate malignant from benign tumors. The aim of this study was to identify predictors of malignancy using contrast-enhanced endoscopic ultrasound (CE-EUS). SUBJECTS AND METHODS: In our institute, main duct type and mixed type IPMNs, branch duct type IPMNs with mural nodules, and IPMNs with coexistent invasive ductal cancer were indications for surgery. Eighty-seven IPMNs (14 main duct, 25 mixed, and 48 branch duct type) were resected and CE-EUS findings were compared with pathologic findings. Twelve clinicopathological variables and CE-EUS morphologic findings were assessed. Mural nodules defined as blood flow supplied protrusions were classified into 4 types: type I: low papillary nodule, type II: polypoid nodule, type III: papillary nodule, and type IV: invasive nodule. RESULTS: Forty-two, 26, 16, and 3 were pathologically diagnosed as adenoma, noninvasive carcinoma, invasive IPMNs, and coexistent invasive ductal cancer, respectively. Multivariable logistic regression analysis showed that types III/IV mural nodule (odds ratio =10.8; 95% confidential intervals =2.75-56.1) and symptomatic IPMNs (odds ratio =4.31; 95% confidential intervals =1.37-14.7) were significant for malignancy. For mural nodule diameter, invasive IPMNs were significantly larger, but types III and IV mural nodules were more frequently associated with malignancy, particularly invasive cancer, at 88.9% and 91.7%, respectively. The diagnosis of IPMNs with types III or IV mural nodule as malignant resulted in a sensitivity of 60%, specificity of 92.9%, and accuracy of 75.9%. CONCLUSIONS: In conclusion, new morphologic criteria were useful to identify the malignant potentials of IPMNs.

Original languageEnglish
Pages (from-to)628-634
Number of pages7
JournalAnnals of Surgery
Volume249
Issue number4
DOIs
Publication statusPublished - 01-04-2009
Externally publishedYes

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Pancreatic Neoplasms
Neoplasms
Odds Ratio
Carcinoma, Intraductal, Noninfiltrating
Adenoma

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Ohno, Eizaburo ; Hirooka, Yoshiki ; Itoh, Akihiro ; Ishigami, Masatoshi ; Katano, Yoshiaki ; Omiya, Naoki ; Niwa, Yasumasa ; Goto, Hidemi. / Intraductal papillary mucinous neoplasms of the pancreas : Differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules. In: Annals of Surgery. 2009 ; Vol. 249, No. 4. pp. 628-634.
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abstract = "BACKGROUND AND AIM: Intraductal papillary mucinous neoplasms (IPMNs) have a wide pathologic spectrum and it is difficult to differentiate malignant from benign tumors. The aim of this study was to identify predictors of malignancy using contrast-enhanced endoscopic ultrasound (CE-EUS). SUBJECTS AND METHODS: In our institute, main duct type and mixed type IPMNs, branch duct type IPMNs with mural nodules, and IPMNs with coexistent invasive ductal cancer were indications for surgery. Eighty-seven IPMNs (14 main duct, 25 mixed, and 48 branch duct type) were resected and CE-EUS findings were compared with pathologic findings. Twelve clinicopathological variables and CE-EUS morphologic findings were assessed. Mural nodules defined as blood flow supplied protrusions were classified into 4 types: type I: low papillary nodule, type II: polypoid nodule, type III: papillary nodule, and type IV: invasive nodule. RESULTS: Forty-two, 26, 16, and 3 were pathologically diagnosed as adenoma, noninvasive carcinoma, invasive IPMNs, and coexistent invasive ductal cancer, respectively. Multivariable logistic regression analysis showed that types III/IV mural nodule (odds ratio =10.8; 95{\%} confidential intervals =2.75-56.1) and symptomatic IPMNs (odds ratio =4.31; 95{\%} confidential intervals =1.37-14.7) were significant for malignancy. For mural nodule diameter, invasive IPMNs were significantly larger, but types III and IV mural nodules were more frequently associated with malignancy, particularly invasive cancer, at 88.9{\%} and 91.7{\%}, respectively. The diagnosis of IPMNs with types III or IV mural nodule as malignant resulted in a sensitivity of 60{\%}, specificity of 92.9{\%}, and accuracy of 75.9{\%}. CONCLUSIONS: In conclusion, new morphologic criteria were useful to identify the malignant potentials of IPMNs.",
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Intraductal papillary mucinous neoplasms of the pancreas : Differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules. / Ohno, Eizaburo; Hirooka, Yoshiki; Itoh, Akihiro; Ishigami, Masatoshi; Katano, Yoshiaki; Omiya, Naoki; Niwa, Yasumasa; Goto, Hidemi.

In: Annals of Surgery, Vol. 249, No. 4, 01.04.2009, p. 628-634.

Research output: Contribution to journalArticle

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T1 - Intraductal papillary mucinous neoplasms of the pancreas

T2 - Differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules

AU - Ohno, Eizaburo

AU - Hirooka, Yoshiki

AU - Itoh, Akihiro

AU - Ishigami, Masatoshi

AU - Katano, Yoshiaki

AU - Omiya, Naoki

AU - Niwa, Yasumasa

AU - Goto, Hidemi

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AB - BACKGROUND AND AIM: Intraductal papillary mucinous neoplasms (IPMNs) have a wide pathologic spectrum and it is difficult to differentiate malignant from benign tumors. The aim of this study was to identify predictors of malignancy using contrast-enhanced endoscopic ultrasound (CE-EUS). SUBJECTS AND METHODS: In our institute, main duct type and mixed type IPMNs, branch duct type IPMNs with mural nodules, and IPMNs with coexistent invasive ductal cancer were indications for surgery. Eighty-seven IPMNs (14 main duct, 25 mixed, and 48 branch duct type) were resected and CE-EUS findings were compared with pathologic findings. Twelve clinicopathological variables and CE-EUS morphologic findings were assessed. Mural nodules defined as blood flow supplied protrusions were classified into 4 types: type I: low papillary nodule, type II: polypoid nodule, type III: papillary nodule, and type IV: invasive nodule. RESULTS: Forty-two, 26, 16, and 3 were pathologically diagnosed as adenoma, noninvasive carcinoma, invasive IPMNs, and coexistent invasive ductal cancer, respectively. Multivariable logistic regression analysis showed that types III/IV mural nodule (odds ratio =10.8; 95% confidential intervals =2.75-56.1) and symptomatic IPMNs (odds ratio =4.31; 95% confidential intervals =1.37-14.7) were significant for malignancy. For mural nodule diameter, invasive IPMNs were significantly larger, but types III and IV mural nodules were more frequently associated with malignancy, particularly invasive cancer, at 88.9% and 91.7%, respectively. The diagnosis of IPMNs with types III or IV mural nodule as malignant resulted in a sensitivity of 60%, specificity of 92.9%, and accuracy of 75.9%. CONCLUSIONS: In conclusion, new morphologic criteria were useful to identify the malignant potentials of IPMNs.

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