scholarly journals The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Stefano Palmucci ◽  
Claudia Trombatore ◽  
Pietro Valerio Foti ◽  
Letizia Antonella Mauro ◽  
Pietro Milone ◽  
...  
Keyword(s):  
Pancreatic Cysts ◽  
Low Grade ◽  
Imaging Features ◽  
Main Duct ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Radiological Features ◽  
Increased Risk ◽  
Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) represent a group of cystic pancreatic neoplasms with large range of clinical behaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesions originating from the main pancreatic duct, main duct IPMNs (MD-IPMNs), and lesions which arise from secondary branches of parenchyma, denominated branch-duct IPMNs (BD-IPMNs). Management of these cystic lesions is essentially based on clinical and radiological features. The latter have been very well described in the last fifteen years, with many studies published in literature showing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or “worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm), large size (3–5 cm), and intramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic or macrocystic in appearance, with or without communication with main duct. Their imaging features are frequently overlapped with cystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very often proposed for these lesions.

scholarly journals Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

2020 ◽  
Vol 109 (1) ◽  
pp. 34-41
Author(s):  
A. Caravati ◽  
S. Andrianello ◽  
T. Pollini ◽  
M. Biancotto ◽  
A. Balduzzi ◽  
...  
Keyword(s):  
High Volume ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Increased Risk ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

Βλεννοπαραγωγά κυστικά νεοπλάσματα παγκρέατος

2020 ◽  
Author(s):  
Χαριτίνη Σάλλα
Keyword(s):  
Needle Aspiration ◽  
High Grade ◽  
Main Duct ◽  
Ultrasound Guided ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Fine Needle ◽  
Mucinous Cystic Neoplasms ◽  
Mucinous Neoplasms

ΣΚΟΠΟΣ: Η παρούσα διδακτορική διατριβή στοχεύει στην αξιολόγηση των κλινικών, απεικονιστικών και κυτταρολογικών κριτηρίων για την ταυτοποίηση της υψηλόβαθμης δυσπλασίας (high grade dysplasia) / καρκινώματος (HGD/Ca) στα παγκρεατικά βλεννοπαραγωγά κυστικά νεοπλάσματα (ενδοπορικά θηλώδη βλεννώδη νεοπλάσματα, intraductal papillary mucinous neoplasms, IPMNs και βλεννώδη κυστικά νεοπλάσματα, mucinous cystic neoplasms, MCNs). ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ: Συμπεριελήφθησαν 68 διαδοχικά ιστολογικά επιβεβαιωμένα βλεννοπαραγωγά κυστικά νεοπλάσματα που διαγνώστηκαν με αναρρόφηση δια λεπτής βελόνης υπό την κατεύθυνση του ενδοσκοπικού υπερήχου (endoscopic ultrasound-guided fine needle aspiration, EUS-FNA), ειδικότερα 39 ΙPMNs παραπλεύρων κλάδων (branch duct, BD-IPMNs), 21 ΙPMNs του μείζονος παγκρεατικού πόρου (main duct, MD-IPMNs) και 8 MCNs. Οι συσχετίσεις της HGD/Ca στο εγχειρητικό υλικό με τα ευρήματα του EUS και της κυτταρολογίας, τα δημογραφικά χαρακτηριστικά, τις συνήθειες ζωής και τις κλινικές παραμέτρους αξιολογήθηκαν χωριστά για τα IPMNs και τα MCNs. ΑΠΟΤΕΛΕΣΜΑΤΑ: Ηλικία μεγαλύτερη ή ίση των 25 ετών συσχετιζόταν με HGD/Ca. Στα BD-IPMNs, η διάμετρος κύστεως μεγαλύτερη ή ίση των 3 cm (ευαισθησία 68,8%, ειδικότητα 65,2%), η παρουσία τοιχωματικού όζου (ευαισθησία 56,3%, ειδικότητα 78,3%), η διάμετρος του μείζονος παγκρεατικού πόρου 5-9 mm (ευαισθησία 50,0%, ειδικότητα 87,0%) και τα ύποπτα για κακοήθεια κυτταρολογικά ευρήματα (ευαισθησία 81,3%, ειδικότητα 100,0%) ήταν ενδεικτικά παρουσίας HGD/Ca. Ομοίως, στα MD-IPMNs, τα ύποπτα για κακοήθεια κυτταρολογικά ευρήματα ήταν ενδεικτικά HGD/Ca με υψηλή ευαισθησία (88,9%) και εξαιρετική ειδικότητα (100,0%). Όσον αφορά στα κυτταρολογικά κριτήρια, στα BD-IPMNs, η HGD/Ca συσχετιζόταν με υψηλή πυρηνοκυτταροπλασματική αναλογία, νέκρωση του υποστρώματος, παρουσία θηλωδών αθροίσεων, υπο- ή υπερχρωματικών πυρήνων και μείζονες ανωμαλίες της πυρηνικής μεμβράνης (πάχυνση ή/και οδοντώσεις). ΣΥΜΠΕΡΑΣΜΑΤΑ: Τα κλινικά, απεικονιστικά και κυτταρολογικά κριτήρια είναι χρήσιμα στην ταυτοποίηση της HGD/Ca στα IPMNs.

scholarly journals A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts

2016 ◽  
Vol 24 (1) ◽  
pp. 145-152 ◽  
Author(s):  
David L Masica ◽  
Marco Dal Molin ◽  
Christopher L Wolfgang ◽  
Tyler Tomita ◽  
Mohammad R Ostovaneh ◽  
...  
Keyword(s):  
Pancreatic Cyst ◽  
Pancreatic Cysts ◽  
Clinical Markers ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Serous Cystadenomas ◽  
Mucinous Neoplasms ◽  
Independent Cohort ◽  
Solid Pseudopapillary Neoplasms

Objective: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification. Materials and Methods: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts. Results: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively. Conclusions: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.

scholarly journals The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

2015 ◽  
Vol 143 (5-6) ◽  
pp. 332-336 ◽  
Author(s):  
Dejan Stevanovic ◽  
Dragos Stojanovic ◽  
Nebojsa Mitrovic ◽  
Damir Jasarovic ◽  
Sanja Milenkovic ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
The Body ◽  
Pancreatic Tumors ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Gastric Type ◽  
Branch Duct Type ◽  
Laparoscopic Enucleation

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8?5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

Molecular Characterization and Pathogenesis of Intraductal Papillary Mucinous Neoplasms of the Pancreas

2015 ◽  
Vol 55 (4) ◽  
pp. 352-363 ◽  
Author(s):  
Julia Benzel ◽  
Volker Fendrich
Keyword(s):  
Pancreatic Neoplasms ◽  
Main Pancreatic Duct ◽  
Mixed Type ◽  
Pancreatic Tissue ◽  
Molecular Characteristics ◽  
Main Duct ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Normal Pancreatic Tissue ◽  
Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are noninvasive neoplasms which occur in the main pancreatic duct or its major branches. IPMNs have an important meaning in the clinic and in research since they represent around 20% of all resected pancreatic neoplasms. Morphologically, branch duct, main duct and mixed-type IPMNs can be distinguished. Histologically, they can be divided into gastric, intestinal, pancreatobiliary and oncocytic type. There are different mutations in genes such as KRAS, GNAS, RNF43 and p53. The expression of miRNAs is specific to IPMNs; altogether, 14 miRNAs have been identified so far which are differently expressed in all IPMNs in contrast to normal pancreatic tissue. It has also been observed that methylation levels can be altered in IPMNs. This review summarizes the molecular characteristics of IPMNs of the pancreas and presents currently known markers.

scholarly journals Neutrophil to Lymphocyte Ratio is a Predictive Factor of Malignant Potential for Intraductal Papillary Mucinous Neoplasms of the pancreas

2019 ◽  
Vol 14 ◽  
pp. 117727191985150 ◽  
Author(s):  
Riki Ohno ◽  
Ryuichi Kawamoto ◽  
Mami Kanamoto ◽  
Jota Watanabe ◽  
Masahiko Fujii ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Malignant Potential ◽  
Neutrophil To Lymphocyte Ratio ◽  
Mural Nodule ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cystic Neoplasms ◽  
Lymphocyte Ratio ◽  
Mucinous Neoplasms ◽  
Malignant Ipmn

Intraductal papillary mucinous neoplasms (IPMNs) are cystic neoplasms with the potential for progression to pancreatic cancer. Accurate prediction of the malignant potential is challenging and a proper treatment strategy has not been well established. Preoperative neutrophil-to-lymphocyte ratio (NLR) is a biomarker of the malignant potential in patients with several types of malignancy. We explored malignant potential in patients with IPMN. The present study included 56 patients aged of 73 ± 9 years (mean ± standard deviation) who underwent curative resection for IPMN from 1996 to 2017. We analyzed the relationship between the characteristics including NLR and malignant component for predicting pathological results. The nonmalignant IPMN group (N = 21) included patients with low-grade dysplasia (LGD) and intermediate-grade dysplasia (IGD), and the malignant IPMN group (N = 35) included patients with high-grade dysplasia (HGD) and invasive carcinoma. In a univariate analysis, NLR ⩾ 2.2 ( P = .001), prognostic nutritional index (PNI) < 45 ( P = .016), CA 19-9 > 37 U/mL ( P = .039), and cystic diameter ⩾ 30 mm ( P = .010), and mural nodule ( P = .010) were significantly different between the malignant IPMN and the nonmalignant IPMN groups. Multivariate analysis showed that high NLR (⩾2.2) (odds ratio 9.79; 95% confidence interval: 2.06-45.6), cystic diameter ⩾ 30 mm (4.65; 1.14-18.9), and mural nodule (4.91; 1.20-20.1) were independently predictive of malignant IPMN. These results suggest that preoperative NLR is a useful predictive biomarker for evaluating malignant potential in patients with IPMN.1

scholarly journals Cytological analysis of small branch-duct intraductal papillary mucinous neoplasms provides a more accurate risk assessment of malignancy than symptoms

CytoJournal ◽  
2011 ◽  
Vol 8 ◽  
pp. 21 ◽  
Author(s):  
Jill Ono ◽  
Kurt A. Yaeger ◽  
Muriel Genevay ◽  
Mari Mino-Kenudson ◽  
William R. Brugge ◽  
...  
Keyword(s):  
Predictive Value ◽  
High Threshold ◽  
Imaging Features ◽  
High Grade ◽  
Positive Cytology ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Small Branch ◽  
Mucinous Neoplasms ◽  
Sensitivity Specificity

Objectives: The Sendai guidelines for management of patients with clinically suspected intraductal papillary mucinous neoplasms (IPMN) recommend resection of cysts > 30 mm, a dilated main pancreatic duct (MPD) > 6 mm, a mural nodule (MN), symptoms or positive cytology. Although sensitive, asymptomatic cysts, nonspecific symptoms, and a high threshold for positive cytology limit the specificity of the guidelines. We have assessed the value of cytology relative to symptom for predicting malignancy in IPMNs without high-risk imaging features. Materials and Methods: We retrospectively reviewed the clinical, radiological, and cytological data of 31 small branch-duct IPMNs without a MN. The cytological presence of high-grade atypical epithelial cells (HGA) was considered true positive, with a corresponding histology of high-grade dysplasia or invasive carcinoma. The performance of cytology versus symptoms was evaluated by calculating the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. Results: The sensitivity (0.80), specificity (0.85), and accuracy (0.84) of HGA were higher than the corresponding performance characteristics of symptoms (0.60, 0.45, and 0.48, respectively). The NPV of no HGA on cytology was > 95%. Conclusions: Cytology is a better predictor of malignancy than symptoms, for the conservative management of small branch-duct IPMNs. Cytology contributes to a highly accurate triple negative test for malignancy in small IPMN: No dilated MPD, MN or HGA.

scholarly journals Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas

Surgery Today ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Seiko Hirono ◽  
Hiroki Yamaue
Keyword(s):  
Surgical Resection ◽  
Treatment Strategy ◽  
Mucinous Carcinoma ◽  
Current Treatment ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
International Consensus ◽  
Branch Duct ◽  
Remnant Pancreas ◽  
Mucinous Neoplasms

AbstractThe current treatment strategy for intraductal papillary mucinous neoplasms (IPMNs), based on the international consensus guideline, has been accepted widely. However, reported outcomes after surgical resection for IPMN show that once the tumor progresses to invasive intraductal papillary mucinous carcinoma (IPMC), recurrence is not uncommon. The surgical treatment for IPMN is invasive and sometimes followed by complications. Therefore, the best timing for resection might be at the point when high-grade dysplasia (HGD) is evident. According to previous reports, main duct type IPMN has a high malignant potential and its surgical resection is universally accepted, whereas, the incidence of HGD/invasive IPMC in branch duct and mixed type IPMNs is thought to be lower. In addition to mural nodules and a dilated main pancreatic duct, cytology and measurement of the carcinoembryonic antigen level in the pancreatic juice might be useful to differentiate HGD/invasive IPMC from low-grade dysplasia. The nomogram proposed recently to predict the risk of HGD/invasive IPMC in IPMN patients might help surgeons decide on the best treatment strategy, depending on the patient’s age and general condition. Second resection for high-risk lesions in the remnant pancreas might improve the survival of IPMN patients.

Imaging Features to Distinguish Malignant and Benign Branch-Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

2014 ◽  
Vol 259 (1) ◽  
pp. 72-81 ◽  
Author(s):  
Kyung Won Kim ◽  
Seong Ho Park ◽  
Junhee Pyo ◽  
Soon Ho Yoon ◽  
Jae Ho Byun ◽  
...  
Keyword(s):  
Imaging Features ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Branch Duct Type
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