Minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high-grade dysplasia or invasive carcinoma |
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| Authors: | Neda Amini Neda Rezaee Joseph R. Habib Alex Blair Ross M. Beckman Lindsey Manos John L. Cameron Ralph H. Hruban Matthew J. Weiss Elliot K. Fishman Atif Zaheer Kelly J. Lafaro Richard A. Burkhart Anne M. O'Broin Lennon William R. Burns Jin He Christopher L. Wolfgang |
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| Affiliation: | 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Department of Pathology, Washington University, Saint Louis, MO, USA;3. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;5. Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;6. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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| Abstract: | BackgroundThe aim of this study was to determine the incidence of high-grade dysplasia (HGD) or invasive carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs).Methods923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) <5 mm, cyst size <3 cm, no mural nodules, negative cyst fluid cytology for adenocarcinoma, or serum carbohydrate antigen 19-9 (CA 19-9) <37 U/L.ResultsBD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated invasive-carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had invasive-carcinoma. Of note, older age (OR 1.13, 95% CI 1.03–1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40–53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment.ConclusionThe risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3–5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a “worrisome feature” in a future guidelines update. |
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