title: Morphological Classification of Intraductal Papillary Neoplasm of the Bile Duct with Survival Correlation
abstract: Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a specific entity for which there has been no
  classification that correlates clinical presentation with patient survival. We, therefore, propose a new classification based
  on radio-pathological appearance correlated with clinical findings including outcome. Methods: We retrospectively
  reviewed the medical and pathological records of 103 IPNB patients who underwent curative-intent hepatic resection
  between January 2008 and December 2011. A morphological classification was then created based on the presence of
  (a) bile duct dilatation, (b) intraductal mass(es), (c) cystic lesion(s), and (d) macro-invasion of the liver. All clinical
  parameters and survival were analyzed. Results: The median survival of IPNB patients was 1,728 days (95%CI: 1,485
  to 1,971 days). The proposed classification predicted survival very well (log-rank test; p < 0.01). For patients with the
  cystic variant and micro-papillary IPNB, there were no tumor-related deaths within 3 years of surgery and median survival
  was not reached during the follow-up. The respective median survival times for IPNBs with unilateral intrahepatic duct
  dilatation, bilateral intrahepatic duct dilatation, and macro-invasion were 1,888 days (95%CI 1,118- 2,657), 673 days
  (95%CI: 392- 953), and 578 days (95%CI: 285- 870). Conclusion: We propose a new classification for IPNBs which
  not only provides a view of patients in terms of their radio-pathologic status but also should help in guiding planning
  of surgical procedures.
authors.affiliation: Department of Surgery, Faculty of Medicine, Khon Kaen University,   Khon Kaen, 40002, Thailand. Email:vor_110@yahoo.com
authors.forename: Vor
authors.initials: V
authors.lastname: Luvira
authors.forename: Kulyada
authors.initials: K
authors.lastname: Somsap
authors.forename: Ake
authors.initials: A
authors.lastname: Pugkhem
authors.forename: Chalerm
authors.initials: Ch
authors.lastname: Eurboonyanun
authors.forename: Varisara
authors.initials: V
authors.lastname: Luvira
authors.forename: Vajarabhongsa
authors.initials: V
authors.lastname: Bhudhisawasdi
authors.forename: Chawalit
authors.initials: Ch
authors.lastname: Pairojkul
authors.forename: Supot
authors.initials: S
authors.lastname: Kamsa Ard
keywords: Intraductal papillary neoplasm of the bile duct; classification; survival