title: Should all branch-duct intraductal papillary mucinous neoplasms be resected?
abstract: BACKGROUND
  The relationship between branch-duct intraductal papillary mucinous neoplasms (IPMNs) and malignancy remains controversial and difficult to assess.
  
  
  METHODS
  Between January 1, 1999 and January 1, 2013, we identified 84 patients with IPMN who underwent resection.
  
  
  RESULTS
  Preoperatively, 55 patients underwent endoscopic ultrasounds and 58 underwent biopsy. Only 7 lesions were specified preoperatively as branch-duct, which inconsistently correlated with the surgical specimen. Of the 82 patients where the duct was specified, there were 33 malignant lesions. There was no correlation between branch-duct origin and invasive carcinoma. Malignant tumor size did not significantly differ by the duct of origin. Of the 28 patients with invasive carcinoma, branch-duct lesions were significantly associated with the presence of positive lymph nodes, perineural invasion, and lymphovascular invasion.
  
  
  CONCLUSIONS
  Our study supports the resection criteria for branch-duct IPMN based on size and symptoms. However, it also questions the reliability of our preoperative testing to rule out malignant branch-duct IPMN lesions.
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Plichta
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Ban
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fridirici
authors.affiliation: Department of Pathology, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Godambe
authors.affiliation: Department of Pathology, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Yong
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Pappas
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 South First Avenue, Maywood, IL 60153, USA. Electronic address: garanha@lumc.edu.
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000601:surgery*; D003657:Decision Making; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: IPMN; Intraductal papillary mucinous neoplasm; Pancreas