title: Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?
abstract: Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7%) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4%) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4%) had invasive carcinoma. Alternatively, 2/50 (4%) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25% of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Barron
authors.forename: A M
authors.initials: AM
authors.lastname: Roch
authors.forename: J A
authors.initials: JA
authors.lastname: Waters
authors.forename: J A
authors.initials: JA
authors.lastname: Parikh
authors.forename: J M
authors.initials: JM
authors.lastname: DeWitt
authors.forename: M A
authors.initials: MA
authors.lastname: Al-Haddad
authors.forename: E P
authors.initials: EP
authors.lastname: Ceppa
authors.forename: M G
authors.initials: MG
authors.lastname: House
authors.forename: N J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: A
authors.initials: A
authors.lastname: Nakeeb
authors.forename: H A
authors.initials: HA
authors.lastname: Pitt
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed