Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience

Abdul El Chafic, Ihab I. El Hajj, John DeWitt, C. Schmidt, Ali Siddiqui, Stuart Sherman, Ashish Aggarwal, Mohammad Al-Haddad

Research output: Contribution to journalArticle

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Abstract

Background: Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign. Aims: To describe cyst size changes over time in BD-IPMNs, and determine whether cyst growth rate is associated with increased risk of malignancy. Methods: This is a retrospective study performed at two high volume tertiary centers. Mean cyst size at baseline (MCSB) and mean growth rate percentage (MGRP) were calculated. Rapid cyst growth was defined as MGRP ≥30%/year. Patient and cyst related characteristics were studied. Results: 160 patients were followed for a median of 27.4 (12–114.5) months. MCSB was 15.1 ± 8.0 mm. During follow-up, 73 (45.6%) showed any cyst size increase, of which 15 cysts (9.4%) exhibited MGRP ≥30%/year. Rapid cyst growth was not associated with patient or cyst characteristics. Cyst fluid molecular analysis from 101 cysts showed KRAS mutation in 26. Compared to KRAS-negative cysts, neither MCSB (16.0 mm vs. 17.7 mm; p = 0.3) nor MGRP (3.9%/year vs. 5.8%/year; p = 0.7) was significantly different. Eighteen patients underwent surgery; 15 (83%) had LGD, and 3 had advanced neoplasia. Two cysts with LGD and one cyst with advanced neoplasia had MGRP ≥30%/year. Conclusion: Increase in BD-IPMNs size was not associated with the known high risk patient or cyst-related characteristics. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.

Original languageEnglish (US)
JournalDigestive and Liver Disease
DOIs
StateAccepted/In press - Jan 1 2018

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Cysts
Growth
Neoplasms
Cyst Fluid
Surgical Pathology
Retrospective Studies

Keywords

  • Branch-duct IPMN (BD-IPMN)
  • CT
  • Cyst growth rate
  • Dysplasia
  • Endoscopic ultrasound
  • Molecular analysis
  • MRI
  • Neoplasia

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience. / El Chafic, Abdul; El Hajj, Ihab I.; DeWitt, John; Schmidt, C.; Siddiqui, Ali; Sherman, Stuart; Aggarwal, Ashish; Al-Haddad, Mohammad.

In: Digestive and Liver Disease, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience",
abstract = "Background: Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign. Aims: To describe cyst size changes over time in BD-IPMNs, and determine whether cyst growth rate is associated with increased risk of malignancy. Methods: This is a retrospective study performed at two high volume tertiary centers. Mean cyst size at baseline (MCSB) and mean growth rate percentage (MGRP) were calculated. Rapid cyst growth was defined as MGRP ≥30{\%}/year. Patient and cyst related characteristics were studied. Results: 160 patients were followed for a median of 27.4 (12–114.5) months. MCSB was 15.1 ± 8.0 mm. During follow-up, 73 (45.6{\%}) showed any cyst size increase, of which 15 cysts (9.4{\%}) exhibited MGRP ≥30{\%}/year. Rapid cyst growth was not associated with patient or cyst characteristics. Cyst fluid molecular analysis from 101 cysts showed KRAS mutation in 26. Compared to KRAS-negative cysts, neither MCSB (16.0 mm vs. 17.7 mm; p = 0.3) nor MGRP (3.9{\%}/year vs. 5.8{\%}/year; p = 0.7) was significantly different. Eighteen patients underwent surgery; 15 (83{\%}) had LGD, and 3 had advanced neoplasia. Two cysts with LGD and one cyst with advanced neoplasia had MGRP ≥30{\%}/year. Conclusion: Increase in BD-IPMNs size was not associated with the known high risk patient or cyst-related characteristics. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.",
keywords = "Branch-duct IPMN (BD-IPMN), CT, Cyst growth rate, Dysplasia, Endoscopic ultrasound, Molecular analysis, MRI, Neoplasia",
author = "{El Chafic}, Abdul and {El Hajj}, {Ihab I.} and John DeWitt and C. Schmidt and Ali Siddiqui and Stuart Sherman and Ashish Aggarwal and Mohammad Al-Haddad",
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T1 - Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience

AU - El Chafic, Abdul

AU - El Hajj, Ihab I.

AU - DeWitt, John

AU - Schmidt, C.

AU - Siddiqui, Ali

AU - Sherman, Stuart

AU - Aggarwal, Ashish

AU - Al-Haddad, Mohammad

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign. Aims: To describe cyst size changes over time in BD-IPMNs, and determine whether cyst growth rate is associated with increased risk of malignancy. Methods: This is a retrospective study performed at two high volume tertiary centers. Mean cyst size at baseline (MCSB) and mean growth rate percentage (MGRP) were calculated. Rapid cyst growth was defined as MGRP ≥30%/year. Patient and cyst related characteristics were studied. Results: 160 patients were followed for a median of 27.4 (12–114.5) months. MCSB was 15.1 ± 8.0 mm. During follow-up, 73 (45.6%) showed any cyst size increase, of which 15 cysts (9.4%) exhibited MGRP ≥30%/year. Rapid cyst growth was not associated with patient or cyst characteristics. Cyst fluid molecular analysis from 101 cysts showed KRAS mutation in 26. Compared to KRAS-negative cysts, neither MCSB (16.0 mm vs. 17.7 mm; p = 0.3) nor MGRP (3.9%/year vs. 5.8%/year; p = 0.7) was significantly different. Eighteen patients underwent surgery; 15 (83%) had LGD, and 3 had advanced neoplasia. Two cysts with LGD and one cyst with advanced neoplasia had MGRP ≥30%/year. Conclusion: Increase in BD-IPMNs size was not associated with the known high risk patient or cyst-related characteristics. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.

AB - Background: Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign. Aims: To describe cyst size changes over time in BD-IPMNs, and determine whether cyst growth rate is associated with increased risk of malignancy. Methods: This is a retrospective study performed at two high volume tertiary centers. Mean cyst size at baseline (MCSB) and mean growth rate percentage (MGRP) were calculated. Rapid cyst growth was defined as MGRP ≥30%/year. Patient and cyst related characteristics were studied. Results: 160 patients were followed for a median of 27.4 (12–114.5) months. MCSB was 15.1 ± 8.0 mm. During follow-up, 73 (45.6%) showed any cyst size increase, of which 15 cysts (9.4%) exhibited MGRP ≥30%/year. Rapid cyst growth was not associated with patient or cyst characteristics. Cyst fluid molecular analysis from 101 cysts showed KRAS mutation in 26. Compared to KRAS-negative cysts, neither MCSB (16.0 mm vs. 17.7 mm; p = 0.3) nor MGRP (3.9%/year vs. 5.8%/year; p = 0.7) was significantly different. Eighteen patients underwent surgery; 15 (83%) had LGD, and 3 had advanced neoplasia. Two cysts with LGD and one cyst with advanced neoplasia had MGRP ≥30%/year. Conclusion: Increase in BD-IPMNs size was not associated with the known high risk patient or cyst-related characteristics. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.

KW - Branch-duct IPMN (BD-IPMN)

KW - CT

KW - Cyst growth rate

KW - Dysplasia

KW - Endoscopic ultrasound

KW - Molecular analysis

KW - MRI

KW - Neoplasia

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DO - 10.1016/j.dld.2018.04.022

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