Value of EUS in early detection of pancreatic ductal adenocarcinomas in patients with intraductal papillary mucinous neoplasms.
OBJECTIVE
Pancreatic ductal adenocarcinomas (PDAC) sometimes arise in patients with intraductal papillary mucinous neoplasms (IPMNs). This study examined the incidence of PDACs concomitant to or derived from branch duct IPMNs. The usefulness of endoscopic ultrasonography (EUS) relative to other imaging methods for detecting these tumors was also assessed.


METHODS
This retrospective study used data from clinical records and imaging studies that were collected prospectively. During 2001-2009, 167 consecutive patients with IPMNs underwent EUS, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). The 102 patients whose branch duct IPMNs lacked mural nodules/symptoms and thus did not qualify for resection were followed up by semiannual EUS and annual ultrasonography, CT, and MRI. The sensitivity and specificity with which the four modalities detected IPMN-derived and -concomitant PDACs at the first examination and throughout the study period were evaluated. The rate of PDAC development during follow-up was analyzed by the Kaplan-Meier method.


RESULTS
A total of 17 IPMN-derived and 11 IPMN-concomitant PDACs were diagnosed at the first examination. Lesions that did not qualify for resection or chemotherapy were followed up for a median of 42 months. Seven IPMN-concomitant PDACs and no IPMN-derived PDACs were detected during follow-up. The 3- and 5-year rates of IPMN-concomitant PDAC development were 4.0% and 8.8%, respectively. At the first examination, EUS was superior to other imaging modalities in terms of IPMN-derived and -concomitant PDAC detection. Throughout the study period, including follow-up, EUS was significantly better at detecting IPMN-concomitant PDACs than the other modalities.


CONCLUSIONS
IPMN-concomitant PDACs are quite often found at diagnosis and during follow-up. EUS examination of the whole pancreas plays an important role in the management of IPMNs as it allows the early detection of these small invasive carcinomas.
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Ken
K
Kamata
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Masayuki
M
Kitano
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Masatoshi
M
Kudo
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Hiroki
H
Sakamoto
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Kumpei
K
Kadosaka
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Takeshi
T
Miyata
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Hajime
H
Imai
Section of Abdominal Ultrasound, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Kiyoshi
K
Maekawa
Department of Pathology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Takaaki
T
Chikugo
Department of Radiology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Masashi
M
Kumano
Department of Radiology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Tomoko
T
Hyodo
Department of Radiology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Takamichi
T
Murakami
Division of Biostatistics, Clinical Research Center, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Yasutaka
Y
Chiba
Department of Surgery, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
Yoshifumi
Y
Takeyama
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology; D000231:Adenocarcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed