title: Endoscopic ultrasonographic findings predict the risk of carcinoma in branch duct intraductal papillary mucinous neoplasms of the pancreas.
abstract: BACKGROUND
  The preoperative diagnosis of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be very difficult, since low-risk and high-risk lesions can be difficult to differentiate even after cytological analysis. The purpose of this study was to evaluate the preoperative diagnostic value of endoscopic ultrasonography (EUS) in differentiating low-risk and high-risk IPMNs.
  
  
  METHODS
  We retrospectively identified 36 patients who underwent preoperative EUS for branch duct IPMNs. The pathological diagnosis after surgical resection was low-grade dysplasia (n = 26), moderate dysplasia (n = 1), high-grade dysplasia or carcinoma in situ (n = 5), and invasive carcinoma (n = 4). We divided the patients into two groups: low risk (low-grade dysplasia or moderate dysplasia) and high risk (high-grade dysplasia or carcinoma). We focused on the diameter of the cystic dilated branch duct, the main pancreatic duct, and the mural nodule as measured using the EUS findings.
  
  
  RESULTS
  The cystic dilated branch duct diameter (31.5 mm vs. 41.9 mm, P = 0.0225) was significantly correlated with low-risk and high-risk IPMNs, but the main pancreatic duct diameter (5.37 mm vs. 5.44 mm, P = 0.9418) was not significantly correlated with the low-risk and high-risk IPMNs. The mural nodule diameter of the papillary protrusions (4.3 mm vs. 16.4 mm, P < 0.0001) and the width diameter of the mural nodule (5.7 mm vs. 23.2 mm, P < 0.0001) were significantly correlated with low-risk and high-risk IPMNs.
  
  
  CONCLUSIONS
  The mural nodule of papillary protrusions diameter and width diameter observed using EUS was a reliable preoperative diagnostic finding capable of distinguishing low-risk and high-risk IPMNs.
authors.affiliation: Gastroenterology Division, Yokohama City University Graduate School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan. norikoba@yokohama-cu.ac.jp
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Seitaro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inayama
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000175:diagnosis; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018579:Patient Selection; D011230:Precancerous Conditions / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies