title: Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology.
abstract: 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.
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. maxschmi@iupui.edu
authors: C Max
authors: CM
authors: Schmidt
authors: Patrick B
authors: PB
authors: White
authors: Joshua A
authors: JA
authors: Waters
authors: Constantin T
authors: CT
authors: Yiannoutsos
authors: Oscar W
authors: OW
authors: Cummings
authors: Marshall
authors: M
authors: Baker
authors: Thomas J
authors: TJ
authors: Howard
authors: Nicholas J
authors: NJ
authors: Zyromski
authors: Atilla
authors: A
authors: Nakeeb
authors: John M
authors: JM
authors: DeWitt
authors: Fatih M
authors: FM
authors: Akisik
authors: Stuart
authors: S
authors: Sherman
authors: Henry A
authors: HA
authors: Pitt
authors: Keith D
authors: KD
authors: Lillemoe
mesh_terms: 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