Should we regard all main duct type intraductal papillary mucinous neoplasms of the pancreas (MD-IPMN) as an indication of surgery? -A retrospective study in 29 patients with MD-IPMN showing mural nodules.
Pancreatology
; 19(2): 352-359, 2019 Mar.
Article
em En
| MEDLINE
| ID: mdl-30679137
ABSTRACT
PURPOSE:
To elucidate predictive factors for malignant main duct type IPMN (MD-IPMN).METHODS:
All 29 subjects had mural nodules (MNs) in the main pancreatic duct (MPD) on preoperative endoscopic ultrasonography and underwent surgery (19, malignant; 10, benign). Possible predictive factors for malignancy such as background, imaging, and histological factors including histological subtype (HS), were evaluated.RESULTS:
Multivariate analysis revealed an MPD diameter of ≥12â¯mm (pâ¯=â¯0.042) and non-gastric type (pâ¯=â¯0.001) to be the statistically significant predictive factors for malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to detect malignancy by using "an MPD diameter of ≥12â¯mm and/or non-gastric type" were 95%, 70%, 86%, 88%, and 86%, respectively. In 7 subjects in whom HS was preoperatively evaluated using pancreatic specimens obtained before surgery, the agreement rate of the preoperative HS with definitive HS evaluated using resected specimens was 86%.CONCLUSIONS:
For MD-IPMNs with MNs, "an MPD diameter of ≥12â¯mm and/or non-gastric type" are indicated for surgery. On the other hand, careful surveillance without immediate pancreatic surgery may be an option for MD-IPMNs showing both an MPD diameter of <12â¯mm and gastric type.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Pancreáticas
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Adenocarcinoma Mucinoso
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Carcinoma Ductal Pancreático
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article