title: Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms.
abstract: OBJECTIVE
  Malignant intraductal papillary mucinous neoplasms (IPMNs) can be predicted before surgery.
  
  
  METHODS
  Retrospective review of a prospectively collected database.
  
  
  METHODS
  Academic, urban, tertiary care hospital.
  
  
  METHODS
  Sixty-four consecutive patients with a pathological diagnosis of IPMN.
  
  
  METHODS
  All 64 patients underwent surgical intervention for IPMN between December 8, 1988, and October 16, 2002.
  
  
  METHODS
  Reliable predictors of malignancy.
  
  
  RESULTS
  The 64 patients underwent 69 operations: 39 pancreaticoduodenectomies, 18 distal pancreatectomies, 7 total pancreatectomies, 4 neck and/or body pancreatectomies, and 1 cystgastrostomy with pancreatic biopsy. Twenty-three of 69 specimens were malignant-12 in situ (high-grade dysplasia) and 11 invasive. In a univariate analysis of 12 clinical signs or symptoms recorded, diabetes mellitus and jaundice showed a significant association with malignancy of IPMN. Of 24 serum chemistry studies, hematologic studies, and tumor marker analyses (in serum, bile, and pancreatic fluid), elevation of serum alkaline phosphatase and glucose levels showed correlation with malignancy. Computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography findings did not distinguish between benign and malignant tumors. Atypia on preoperative cytologic analysis was specific for malignancy (93%) but lacked the same degree of sensitivity (40% in situ, 91% invasive, and 67% overall).
  
  
  CONCLUSIONS
  Malignancy of IPMNs is suggested by new-onset diabetes mellitus, jaundice, and elevations in serum glucose or alkaline phosphatase levels. Atypia on preoperative cytologic testing is the finding most predictive of malignancy. The absence of these features does not predict benign disease. These findings may help guide patient and physician decision making.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, USA. maxschmi@iupui.edu
authors.forename: Chad A
authors.initials: CA
authors.lastname: Wiesenauer
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Oscar W
authors.initials: OW
authors.lastname: Cummings
authors.forename: Constantin T
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goulet
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.forename: Harvey
authors.initials: H
authors.lastname: Cramer
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D011230:Precancerous Conditions / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor