Endoscopic ultrasonographic findings predict the risk of carcinoma in branch duct intraductal papillary mucinous neoplasms of the pancreas |
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| Authors: | Noritoshi Kobayashi Kazuya Sugimori Takeshi Shimamura Kunihiro Hosono Seitaro Watanabe Shingo Kato Michio Ueda Itaru Endo Yoshiaki Inayama Shin Maeda Atsushi Nakajima Kensuke Kubota |
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| Institution: | 1. Gastroenterology Division, Yokohama City University Graduate School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan;2. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan;3. Gastroenterological Surgery Division, Yokohama City University Graduate School of Medicine, Yokohama, Japan;4. Pathological Division, Yokohama City University Graduate School of Medicine, Yokohama, Japan;1. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing 100142, China;2. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing 100142, China;3. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Hepatic Biliary & Pancreatic Surgery, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing 100142, China;1. Gastroenterology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain;2. Gastroenterology Department, University College London Hospital NHS Foundation Trust and the Royal Free Hospital NHS Foundation Trust, London, UK;1. Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;3. Asuragen, Inc, Austin, Texas;4. Department of Pathology and Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida;5. Department of Medicine, Division of Gastroenterology, University of Sherbrooke, Fleurimont, Quebec, Canada;7. Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland;12. Institute of Pathology, Ruhr-University of Bochum, Bochum, Germany;8. Molecular GI-Oncology and Department of Pathology, Ruhr-University of Bochum, Bochum, Germany;9. Department of Pathology and Department of Gasteroenterology and Hepatology, Dartmouth Hitchcock Medical Center and The Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire;1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;2. Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan;3. Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, United States;4. Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, TX, United States;1. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan;2. Department of Human Pathology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan;3. Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan;1. Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;2. Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Istanbul, Turkey;3. Department of Gastroenterology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;4. Department of Radiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;5. Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey |
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| Abstract: | BackgroundThe preoperative diagnosis of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be very difficult, since low-risk and high-risk lesions can be difficult to differentiate even after cytological analysis. The purpose of this study was to evaluate the preoperative diagnostic value of endoscopic ultrasonography (EUS) in differentiating low-risk and high-risk IPMNs.MethodsWe retrospectively identified 36 patients who underwent preoperative EUS for branch duct IPMNs. The pathological diagnosis after surgical resection was low-grade dysplasia (n = 26), moderate dysplasia (n = 1), high-grade dysplasia or carcinoma in situ (n = 5), and invasive carcinoma (n = 4). We divided the patients into two groups: low risk (low-grade dysplasia or moderate dysplasia) and high risk (high-grade dysplasia or carcinoma). We focused on the diameter of the cystic dilated branch duct, the main pancreatic duct, and the mural nodule as measured using the EUS findings.ResultsThe cystic dilated branch duct diameter (31.5 mm vs. 41.9 mm, P = 0.0225) was significantly correlated with low-risk and high-risk IPMNs, but the main pancreatic duct diameter (5.37 mm vs. 5.44 mm, P = 0.9418) was not significantly correlated with the low-risk and high-risk IPMNs. The mural nodule diameter of the papillary protrusions (4.3 mm vs. 16.4 mm, P < 0.0001) and the width diameter of the mural nodule (5.7 mm vs. 23.2 mm, P < 0.0001) were significantly correlated with low-risk and high-risk IPMNs.ConclusionsThe mural nodule of papillary protrusions diameter and width diameter observed using EUS was a reliable preoperative diagnostic finding capable of distinguishing low-risk and high-risk IPMNs. |
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