title: Malignant transformation of branch duct-type intraductal papillary mucinous neoplasms of the pancreas based on contrast-enhanced endoscopic ultrasonography morphological changes: focus on malignant transformation of intraductal papillary mucinous neoplasm itself.
abstract: OBJECTIVE
  The natural history of branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas remains unclear. We conducted a retrospective long-term follow-up study for malignant transformation (MT) of BD-IPMNs focusing on morphological changes.
  
  
  METHODS
  The subjects consisted of 142 patients who underwent contrast-enhanced endoscopic ultrasonography for initial diagnosis from January 2001 with more than 12 months of follow-up. The MT rate, including the co-occurrence of invasive ductal cancer, was evaluated by univariate and multivariate analysis. In addition, on the basis of morphological changes in patients who underwent surgery, the predictive factors for malignant IPMNs were evaluated.
  
  
  RESULTS
  Median follow-up term was 42.5 months (range, 12-105 months). Thirty patients who exhibited morphological changes underwent surgery. Malignant transformation occurred in 9 patients (6.3%), and 5-year MT rate was 10.7%. The co-occurrence of invasive ductal cancer was seen in 5 patients. Multivariate analysis showed that the existence of mural nodules at initial diagnosis and involvement of main pancreatic duct were significant predictors of MT of BD-IPMN.
  
  
  CONCLUSIONS
  Malignant transformation of BD-IPMN is not rare. The observation of morphological changes of main pancreatic duct and nodules, mainly on contrast-enhanced endoscopic ultrasonography, is practical and useful for predicting MT of BD-IPMN itself.
authors.affiliation: Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Eizaburo
authors.initials: E
authors.lastname: Ohno
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Takuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Yuya
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ishigami
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Katano
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D016009:Chi-Square Distribution; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media