title: Predictors of early stages of histological progression of branch duct IPMN.
abstract: BACKGROUND
  An appropriate timing for surgical resection of branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) to achieve sufficient postoperative survival is still unknown.
  
  
  METHODS
  Of 80 patients with histologically proven IPMNs, 61 patients who had BD-IPMN without pancreatic cancer concomitant with IPMN were enrolled in this study. We divided BD-IPMN into four groups according to disease progression: low to intermediate grade of dysplasia (LGD/IGD-IPMN), high grade of dysplasia (HGD-IPMN), minimally invasive IPMN (MI-IPMN: T1a), and invasive IPMN (IN-IPMN: ≥T1b). Indicators of surgical resection were investigated on the basis of pathological findings and postoperative prognosis.
  
  
  RESULTS
  Postoperative survival was distinctly worse for patients with IN-IPMN than for patients with MI-IPMN, HGD-IPMN, and LGD/IGD-IPMN. Postoperative disease-specific 5-year survival rate was 100 % in patients with IN-IPMN, HGD-IPMN, and LGD/IGD-IPMN, by contrast, 40 % in patients with IN-IPMN. The presence of two of the three factors (pancreatitis, serum carbohydrate antigen [CA] 19-9 levels >13 U/mL, and mural nodules) could distinguish HGD-IPMN from LGD/IGD-IPMN with a sensitivity of 92.9 %, specificity of 90.2 %, positive predictive value of 76.5 %, negative predictive value of 97.4 %, and accuracy of 90.9 %.
  
  
  CONCLUSIONS
  To manage patients with BD-IPMN and achieve a good postoperative prognosis, surgical resection should be performed before progression to IN-IPMN.
authors.affiliation: Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan, h-krhr@m3.kufm.kagoshima-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurahara
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iino
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kijima
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D018395:CA-19-9 Antigen