Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms

Khaled Abdeljawad, Krishna C. Vemulapalli, C. Schmidt, John DeWitt, Stuart Sherman, Thomas Imperiale, Mohammad Al-Haddad

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Abstract

Background Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear. Objective To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size. Design Single-center retrospective study of prospectively collected data. Settings Tertiary referral center. Patients and Interventions Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed. Main outcome measurements Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions. Results Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI,.72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9). Limitations Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection. Conclusion Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.

Original languageEnglish
Pages (from-to)623-629
Number of pages7
JournalGastrointestinal Endoscopy
Volume79
Issue number4
DOIs
StatePublished - 2014

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Neoplasms
Pancreatic Ducts
Tertiary Care Centers
Surgical Pathology
ROC Curve
Area Under Curve
Retrospective Studies
Logistic Models
Population

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms. / Abdeljawad, Khaled; Vemulapalli, Krishna C.; Schmidt, C.; DeWitt, John; Sherman, Stuart; Imperiale, Thomas; Al-Haddad, Mohammad.

In: Gastrointestinal Endoscopy, Vol. 79, No. 4, 2014, p. 623-629.

Research output: Contribution to journalArticle

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abstract = "Background Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36{\%} to 100{\%} in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear. Objective To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size. Design Single-center retrospective study of prospectively collected data. Settings Tertiary referral center. Patients and Interventions Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed. Main outcome measurements Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions. Results Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25{\%}) with malignant disease, compared with 25 of 36 symptomatic patients (69{\%}) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95{\%} CI,.72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95{\%} CI, 1.6-4.9). Limitations Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection. Conclusion Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.",
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N2 - Background Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear. Objective To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size. Design Single-center retrospective study of prospectively collected data. Settings Tertiary referral center. Patients and Interventions Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed. Main outcome measurements Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions. Results Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI,.72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9). Limitations Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection. Conclusion Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.

AB - Background Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear. Objective To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size. Design Single-center retrospective study of prospectively collected data. Settings Tertiary referral center. Patients and Interventions Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed. Main outcome measurements Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions. Results Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI,.72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9). Limitations Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection. Conclusion Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.

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