Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology.
OBJECTIVE
Determine whether size and other preoperative parameters predict malignant or invasive intraductal papillary mucinous neoplasia (IPMN).


BACKGROUND
From 1991 to 2006, 150 patients underwent 156 operations for IPMN.


METHODS
Prospectively collected, retrospective review of a single academic institution's experience. All preoperative parameters including a detailed radiologic-based classification of IPMN type, location, distribution, size, number, cytology, and mural nodularity were correlated with IPMN pathology.


RESULTS
Malignant IPMN was present in 32% of cases, whereas 19% of cases were invasive. IPMN type and main pancreatic duct diameter were significant predictors of malignant IPMN (P<0.001). Side-branch lesion number was negatively associated with invasive IPMN (P=0.03). Side-branch size, location, and distribution did not predict IPMN pathology. The presence of mural nodules was associated with malignant and invasive IPMN (P<0.001; P<0.02). Atypical cytopathology was significantly associated with malignant and invasive IPMN (P<0.001; P<0.001). Multivariate analysis demonstrated mural nodularity and atypical cytopathology were predictive of malignancy and/or invasion in branch-type IPMN.


CONCLUSIONS
To lower the rate of invasive pathology, surgery should be recommended for fit patients with main-duct IPMN and for branch-duct IPMN with mural nodularity or positive cytology irrespective of location, distribution, or size.
Schmidt
C Max
CM
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. maxschmi@iupui.edu
White
Patrick B
PB
Waters
Joshua A
JA
Yiannoutsos
Constantin T
CT
Cummings
Oscar W
OW
Baker
Marshall
M
Howard
Thomas J
TJ
Zyromski
Nicholas J
NJ
Nakeeb
Atilla
A
DeWitt
John M
JM
Akisik
Fatih M
FM
Sherman
Stuart
S
Pitt
Henry A
HA
Lillemoe
Keith D
KD
D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate