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KMID : 1188320180120050583
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Gut and Liver
2018 Volume.12 No. 5 p.583 ~ p.590
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Predictors of Malignancy in “Pure” Branch-Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas without Enhancing Mural Nodules on CT Imaging: A Nationwide Multicenter Study
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Kim Tae-Hyeon
Woo Young-Sik
Chon Hyung-Ku
Hwang Jin-Hyeok
Yoo Kyo-Sang
Lee Woo-Jin
Lee Kwang-Hyuck
Lee Jong-Kyun
Dong Seok-Ho
Park Chang-Hwan
Park Eun-Taek
Moon Jong-Ho
Kim Ho-Gak
Cho Kwang-Bum
Kim Hong-Ja
Lee Seung-Ok
Cheon Young-Koog
Lee Jeong-Mi
Park Jin-Woo
Kim Myung-Hwan
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Abstract
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Background/Aims: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT.
Methods: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy.
Results: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant.
Conclusions: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
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KEYWORD
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Branch duct-IPMN, Neoplasms, Multicenter study, Mural nodule
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