title: Imaging morphological changes of intraductal papillary mucinous neoplasm of the pancreas was associated with its malignant transformation but not with development of pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  A considerable number of branch duct intraductal papillary mucinous neoplasm (BD-IPMN) developed not infrequently pancreatic malignancy, either as part of IPMN (malignant IPMN) or as concomitant pancreatic ductal adenocarcinoma (PDAC). To date, imaging morphological changes predicting occurrence of malignancy in BD-IPMN are not well-investigated. This study aimed to evaluate the relationships between occurrence of malignancy in BD-IPMN and imaging morphological changes of the tumors observed during follow-up.
  
  
  METHODS
  515 BD-IPMN patients with mural nodule <10 mm and negative cytology were included. 19 patients developed malignant IPMN and 8 patients developed concomitant PDAC during mean follow-up of 4.7 years. The following imaging morphological features were assessed: cyst/main pancreatic duct (MPD) diameter, occurrence of additional cyst/mural nodule.
  
  
  RESULTS
  Growth rate of cyst/MPD diameter were significantly larger in patients who developed malignant IPMN compared to those in patients whose IPMN remained benign (p = 0.013, p = 0.01). Occurrence of additional cyst/mural nodule were more frequently observed in patients who developed malignant IPMN (p = 0.009, p = 0.04). In contrast, none of the factors associated with imaging morphological changes of IPMN were shown to be significantly different between patients who developed concomitant PDAC and patients whose IPMN remained benign. Growth rate of MPD diameter and occurrence of additional cyst were independent factors associated with development of malignant IPMN (odds ratio 21.5, and 5.62, respectively).
  
  
  CONCLUSIONS
  Imaging morphological changes of IPMN, such as growth rate of MPD diameter and occurrence of additional cyst, could be indicators for development of malignant IPMN, but not for development of concomitant PDAC.
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan; Department of Hepatopancreatobiliary Medicine, Kanazawa Medical University Japan. Electronic address: natz.kawada@gmail.com.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Kawada
authors.affiliation: Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uehara
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Department of Hepatopancreatobiliary Medicine, Kanazawa Medical University Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Tsuchishima
authors.affiliation: Department of Hepatopancreatobiliary Medicine, Kanazawa Medical University Japan.
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Tsutsumi
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*
keywords: Concomitant PDAC; Fukuoka guidelines; IPMN; Malignant transformation; Methods of follow-up; Morphological changes