Management of Branch‐duct Intraductal Papillary Mucinous Neoplasms: A Large Single Center Study to Assess Predictors of Malignancy and Long Term Outcomes
dc.contributor.author | Ridtitid, Wiriyaporn | |
dc.contributor.author | DeWitt, John M. | |
dc.contributor.author | Schmidt, C. Max | |
dc.contributor.author | Roch, Alexandra | |
dc.contributor.author | Stuart, Jennifer Schaffter | |
dc.contributor.author | Sherman, Stuart | |
dc.contributor.author | Al-Haddad, Mohammad A. | |
dc.contributor.department | Department of Medicine, IU School of Medicine | en_US |
dc.date.accessioned | 2017-06-30T19:17:23Z | |
dc.date.available | 2017-06-30T19:17:23Z | |
dc.date.issued | 2016-09 | |
dc.description.abstract | Background and Aims Management of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging. We determined factors associated with malignancy in BD-IPMNs and long-term outcomes. Methods This retrospective cohort study included all patients with established BD-IPMNs by the International Consensus Guidelines (ICG) 2012 and/or pathologically confirmed BD-IPMNs in a tertiary care referral center between 2001 and 2013. Main outcome measures were the association between high-risk stigmata (HRS)/worrisome features (WFs) of the ICG 2012 and malignant BD-IPMNs, performance characteristics of EUS-FNA for the diagnosis of malignant BD-IPMNs, and recurrence and long-term outcomes of BD-IPMN patients undergoing surgery or imaging surveillance. Results Of 364 BD-IPMN patients, 229 underwent imaging surveillance and 135 underwent surgery. Among the 135 resected BD-IPMNs, HRS/WFs on CT/magnetic resonance imaging (MRI) were similar between the benign and malignant groups, but main pancreatic duct (MPD) dilation (5-9 mm) was more frequently identified in malignant lesions. On EUS-FNA, mural nodules, MPD features suspicious for involvement, and suspicious/positive malignant cytology were more frequently detected in the malignant group with a sensitivity, specificity, and accuracy of 33%, 94%, and 86%; 42%, 91%, and 83%; and 33% 91%, and 82%, respectively. Mural nodules identified by EUS were missed by CT/MRI in 28% in the malignant group. Patients with malignant lesions had a higher risk of any IPMN recurrence during a mean follow-up period of 131 months (P = .01). Conclusions Among HRS and WFs of the ICG 2012, an MPD size of 5 to 9 mm on CT/MRI was associated with malignant BD-IPMNs. EUS features including mural nodules, MPD features suspicious for involvement, and suspicious/malignant cytology were accurate and highly specific for malignant BD-IPMNs. Our study highlights the incremental value of EUS-FNA over imaging in identifying malignant BD-IPMNs, particularly in patients without WFs and those with smaller cysts. Benign IPMN recurrence was observed in some patients up to 8 years after resection. | en_US |
dc.eprint.version | Author's manuscript | en_US |
dc.identifier.citation | Ridtitid, W., DeWitt, J. M., Schmidt, C. M., Roch, A., Stuart, J. S., Sherman, S., & Al-Haddad, M. A. (2016). Management of branch-duct intraductal papillary mucinous neoplasms: a large single-center study to assess predictors of malignancy and long-term outcomes. Gastrointestinal Endoscopy, 84(3), 436–445. https://doi.org/10.1016/j.gie.2016.02.008 | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/13304 | |
dc.language.iso | en | en_US |
dc.publisher | Elsevier | en_US |
dc.relation.isversionof | 10.1016/j.gie.2016.02.008 | en_US |
dc.relation.journal | Gastrointestinal Endoscopy | en_US |
dc.rights | Publisher Policy | en_US |
dc.source | Author | en_US |
dc.subject | EUS-FNA | en_US |
dc.subject | branch-duct intraductal papillary mucinous neoplasms | en_US |
dc.subject | high-risk stigmata | en_US |
dc.title | Management of Branch‐duct Intraductal Papillary Mucinous Neoplasms: A Large Single Center Study to Assess Predictors of Malignancy and Long Term Outcomes | en_US |
dc.type | Article | en_US |