BACKGROUND AND AIMS: Recent consensus guidelines suggest that presence of > or =1 of the following is an indication for resection (IR) of branch duct intraductal papillary mucinous neoplasm (IPMN-Br): cyst-related symptoms, main pancreatic duct diameter > or =10 mm, cyst size > or =30 mm, intramural nodules, or cyst fluid cytology suspicious/positive for malignancy. Among a cohort of patients with IPMN-Br we determined if the consensus IR (CIR), presence of multifocal IPMN-Br, or growth of cyst size on follow-up predict malignancy. METHODS: We identified 147 patients with IPMN-Br of whom 66 underwent surgical resection at diagnosis and 81 were followed conservatively, of whom 11 were resected during follow-up. Clinical, imaging, histological, and cyst fluid characteristics from all 147 patients with IPMN-Br were obtained from clinical records and/or by contacting the patients. In all cases, presence of CIR at baseline and during follow-up (N = 66), presence of multifocal cysts (N = 57), and increase in cyst size (N = 38) were noted. RESULTS: Among the 77 resected IPMN-Brs, at initial evaluation 61 had at least one CIR and 16 had none. Malignancy was present in 9/61 (15%) with CIR and 0/16 without IR (P= 0.1). When presence of any one of the CIR was taken as an indicator of malignancy, the CIR had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 23%, 14%, and 100%, respectively. Prevalence of malignancy in those with single versus multifocal IPMN-Br was similar (13%vs 11%). No patient has developed malignancy after a median follow-up of 15 months. So far, none of the 38 patients with increase in cyst size on follow-up has developed malignancy related symptoms. CONCLUSIONS: Suggested consensus indications for resection identify all patients with malignancy; however, their specificity is low. In the short term it would be safe to follow patients without these features.
BACKGROUND AND AIMS: Recent consensus guidelines suggest that presence of > or =1 of the following is an indication for resection (IR) of branch duct intraductal papillary mucinous neoplasm (IPMN-Br): cyst-related symptoms, main pancreatic duct diameter > or =10 mm, cyst size > or =30 mm, intramural nodules, or cyst fluid cytology suspicious/positive for malignancy. Among a cohort of patients with IPMN-Br we determined if the consensus IR (CIR), presence of multifocal IPMN-Br, or growth of cyst size on follow-up predict malignancy. METHODS: We identified 147 patients with IPMN-Br of whom 66 underwent surgical resection at diagnosis and 81 were followed conservatively, of whom 11 were resected during follow-up. Clinical, imaging, histological, and cyst fluid characteristics from all 147 patients with IPMN-Br were obtained from clinical records and/or by contacting the patients. In all cases, presence of CIR at baseline and during follow-up (N = 66), presence of multifocal cysts (N = 57), and increase in cyst size (N = 38) were noted. RESULTS: Among the 77 resected IPMN-Brs, at initial evaluation 61 had at least one CIR and 16 had none. Malignancy was present in 9/61 (15%) with CIR and 0/16 without IR (P= 0.1). When presence of any one of the CIR was taken as an indicator of malignancy, the CIR had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 23%, 14%, and 100%, respectively. Prevalence of malignancy in those with single versus multifocal IPMN-Br was similar (13%vs 11%). No patient has developed malignancy after a median follow-up of 15 months. So far, none of the 38 patients with increase in cyst size on follow-up has developed malignancy related symptoms. CONCLUSIONS: Suggested consensus indications for resection identify all patients with malignancy; however, their specificity is low. In the short term it would be safe to follow patients without these features.
Authors: Hanno Matthaei; Alexis L Norris; Athanasios C Tsiatis; Kelly Olino; Seung-Mo Hong; Marco dal Molin; Michael G Goggins; Marcia Canto; Karen M Horton; Keith D Jackson; Paola Capelli; Giuseppe Zamboni; Laura Bortesi; Toru Furukawa; Shinichi Egawa; Masaharu Ishida; Shigeru Ottomo; Michiaki Unno; Fuyuhiko Motoi; Christopher L Wolfgang; Barish H Edil; John L Cameron; James R Eshleman; Richard D Schulick; Anirban Maitra; Ralph H Hruban Journal: Ann Surg Date: 2012-02 Impact factor: 12.969
Authors: Reto M Käppeli; Sascha A Müller; Bianka Hummel; Christina Kruse; Philip Müller; Jürgen Fornaro; Alexander Wilhelm; Marcel Zadnikar; Bruno M Schmied; Ignazio Tarantino Journal: Langenbecks Arch Surg Date: 2013-09-03 Impact factor: 3.445
Authors: Timothy B Gardner; Lisa M Glass; Kerrington D Smith; Gregory H Ripple; Richard J Barth; David A Klibansky; Thomas A Colacchio; Michael J Tsapakos; Arief A Suriawinata; Gregory J Tsongalis; J Marc Pipas; Stuart R Gordon Journal: Am J Gastroenterol Date: 2013-10 Impact factor: 10.864
Authors: Rohit R Sharma; Mark J London; Laura L Magenta; Mitchell C Posner; Kevin K Roggin Journal: J Gastrointest Surg Date: 2009-06-10 Impact factor: 3.452