Does Preoperative Cross-Sectional Imaging Accurately Predict Main Duct Involvement in Intraductal Papillary Mucinous Neoplasm?

M. R. Barron, A. M. Roch, J. A. Waters, J. A. Parikh, John DeWitt, M. A. Al-Haddad, E. P. Ceppa, Michael House, Nicholas Zyromski, Attila Nakeeb, H. A. Pitt, C. Schmidt

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Abstract

Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7 %) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4 %) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4 %) had invasive carcinoma. Alternatively, 2/50 (4 %) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25 % of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.

Original languageEnglish
Pages (from-to)447-456
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number3
DOIs
StatePublished - Mar 2014

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Pancreatic Ducts
Neoplasms
Pathology
Carcinoma
Magnetic Resonance Cholangiopancreatography

Keywords

  • Cross-sectional imaging studies
  • Intraductal papillary mucinous neoplasm (IPMN)
  • Pathology

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Does Preoperative Cross-Sectional Imaging Accurately Predict Main Duct Involvement in Intraductal Papillary Mucinous Neoplasm? / Barron, M. R.; Roch, A. M.; Waters, J. A.; Parikh, J. A.; DeWitt, John; Al-Haddad, M. A.; Ceppa, E. P.; House, Michael; Zyromski, Nicholas; Nakeeb, Attila; Pitt, H. A.; Schmidt, C.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 3, 03.2014, p. 447-456.

Research output: Contribution to journalArticle

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abstract = "Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7 {\%}) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4 {\%}) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4 {\%}) had invasive carcinoma. Alternatively, 2/50 (4 {\%}) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25 {\%} of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.",
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