ABSTRACT
OBJECTIVES: The 2012 international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas stratified patients into 2 clinical categories, "high-risk stigmata" and "worrisome features," and recommended different therapeutic strategies for these groups. The aim of this study was to elucidate the significance of these categories in terms of predicting malignant IPMNs. METHODS: The medical records of 100 consecutive patients who underwent pancreatectomy for IPMNs were retrospectively reviewed. Seventy patients with branch duct IPMNs (BD-IPMNs) were stratified into 3 groups. The relationships between the number of predictive factors and histopathologic grade were investigated. RESULTS: The prevalence rates of malignant IPMN, invasive carcinoma, and lymph node metastasis in the high-risk group were 80%, 55%, and 20%, respectively, with these percentages significantly increasing in a stepwise manner according to the number of predictive factors. In contrast, there was no significant correlation between the number of worrisome features and grade of malignancy in patients stratified as having worrisome BD-IPMNs. CONCLUSIONS: The number of high-risk stigmata correlated significantly with the grade of malignancy of BD-IPMNs. The presence of at least 1 high-risk stigma in patients with BD-IPMNs indicates a need for pancreatectomy with lymphadenectomy.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Carcinoma, Pancreatic Ductal/pathology , Pancreatic Ducts/pathology , Pancreatic Neoplasms/pathology , Adenocarcinoma, Mucinous/classification , Adenocarcinoma, Mucinous/epidemiology , Adenocarcinoma, Mucinous/secondary , Adult , Aged , Carcinoma, Pancreatic Ductal/classification , Carcinoma, Pancreatic Ductal/epidemiology , Carcinoma, Pancreatic Ductal/secondary , Diagnostic Imaging , Disease Management , Female , Humans , Japan/epidemiology , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Grading/standards , Neoplasm Invasiveness , Pancreatectomy , Pancreatic Neoplasms/classification , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/surgery , Practice Guidelines as Topic , Retrospective StudiesABSTRACT
OBJECTIVES: Aberrant expression of several microRNAs (miRs) has been reported in various neoplasms including intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. MicroRNA-196a (miR-196a) is up-regulated in Barrett esophagus (characterized by intestinal metaplasia) and in colorectal cancer; this relationship between intestinal characteristics and miR-196a might also be applicable to intestinal-type IPMNs. The aim of this study was to evaluate whether intestinal-type IPMNs can be discriminated from non-intestinal-type IPMNs by the expression level of miR-196a in tissue and pancreatic juice samples. METHODS: Thirty-seven formalin-fixed paraffin-embedded tissue samples (including 3 of normal pancreatic ducts) and 36 pancreatic juice samples were obtained. The expression level of miR-196a measured by quantitative reverse transcription-polymerase chain reaction assays was compared between intestinal-type and non-intestinal-type IPMNs. RESULTS: MicroRNA-196a expression in intestinal-type IPMN tissue samples (n = 18) was significantly higher than that of non-intestinal-type IPMNs (n = 16) (P < 0.001). Similarly, miR-196a expression in pancreatic juice samples of intestinal-type IPMNs (n = 6) was significantly higher than that of non-intestinal-type IPMNs (n = 30) (P = 0.008), and the sensitivity and specificity for prediction of intestinal-type IPMNs using pancreatic juice samples were both 83%. CONCLUSIONS: Elevated expression of miR-196a in pancreatic juice samples is predictive of intestinal-type IPMNs.
Subject(s)
Adenocarcinoma, Mucinous/genetics , Adenocarcinoma, Papillary/genetics , Carcinoma, Pancreatic Ductal/genetics , Gene Expression Regulation, Neoplastic , MicroRNAs/genetics , Pancreatic Neoplasms/genetics , Adenocarcinoma, Mucinous/diagnosis , Adenocarcinoma, Papillary/diagnosis , Aged , Biomarkers, Tumor/genetics , Carcinoma, Pancreatic Ductal/diagnosis , Diagnosis, Differential , Female , Humans , Intestines/pathology , Male , Pancreatic Juice/metabolism , Pancreatic Neoplasms/diagnosis , Predictive Value of Tests , Prognosis , ROC Curve , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
BACKGROUND: A dilated orifice of the duodenal papilla found during screening endoscopy or ERCP is well-known as one of the specific findings of intraductal papillary mucinous neoplasm (IPMN). However, its clinical significance is still unclear. OBJECTIVE: To assess the diagnostic significance of a dilated orifice of the duodenal papilla and evaluate whether this could be a factor predictive of malignancy or a subtype of IPMN. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: This study involved 149 patients who underwent pancreatectomy for IPMN between January 1987 and June 2011. INTERVENTION: ERCP. MAIN OUTCOME MEASUREMENTS: The rate of malignant and intestinal type IPMNs in patients with and without papillary dilation. RESULTS: A dilated orifice of the duodenal papilla was significantly associated with intestinal type IPMN (P < .001), but this finding could not predict the malignant grade of IPMN (P = .13). Multivariate analysis revealed that a dilated orifice was a significant factor for predicting intestinal type in both main duct (P = .01) and branch duct IPMNs (P < .001). LIMITATIONS: The validity of the definition of papillary dilation, selection bias, and a retrospective study. CONCLUSION: A dilated orifice of the duodenal papilla could be a significant factor for predicting intestinal type IPMN. This may lead to better clinical management of patients with IPMN.