How often does a mixed type intraductal papillary mucinous neoplasm on imaging indicate pathological involvement of the main pancreatic duct?

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2025-06-05 DOI:10.1111/den.15051

Kosuke Takahashi, Ichiro Yasuda, Toshiki Entani, Iori Motoo, Nobuhiko Hayashi, Takayuki Ando, Haruka Fujinami, Kazuto Tajiri, Johji Imura, Kenichi Hirabayashi, Eisuke Ozawa, Hisamitsu Miyaaki, Kazuhiko Nakao

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引用次数: 0

Abstract

Objectives

A pancreatic cyst >5 mm in diameter that communicates with the dilated main pancreatic duct (MPD) ≥5 mm on imaging is defined as mixed type intraductal papillary mucinous neoplasm (MX-IPMN). However, the frequency of tumor involvement of the MPD in MX-IPMN remains unknown. This study investigated how often MX-IPMNs involve the MPD and whether MPD involvement can be diagnosed by peroral pancreatoscopy (POPS).

Methods

This retrospective cohort study included patients who underwent POPS for MX-IPMN followed by surgical resection between July 2018 and December 2021. The pathological features of MX-IPMN, including tumor extension to the MPD, were analyzed. Additionally, the diagnostic performance of various imaging modalities in detecting tumor extension to the MPD was evaluated.

Results

Among a total of 15 patients, 10 (67%) had pathologically confirmed tumor extension to the MPD. In most cases with pathologically confirmed MPD involvement, the main tumor was diagnosed as high-grade dysplasia (60%) or invasive carcinoma (10%). Conversely, low-grade dysplasia was the main lesion in most cases without MPD involvement (low-grade dysplasia 80%; high-grade dysplasia 20%, invasive carcinoma 0%). The diagnostic accuracy, sensitivity, and specificity of POPS with or without biopsy was 93.3%, 90.0%, and 100%, respectively. POPS demonstrated higher accuracy and sensitivity than computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (accuracy: 93.3%, 40%, 60%, and 80%; sensitivity: 93.3%, 10%, 40%, and 70%, respectively).

Conclusions

Overall, 67% of MX-IPMNs had pathologically proven MPD involvement. Tumor extension to the MPD is highly suspicious of malignancy, and POPS may be useful for evaluating MPD involvement.

查看原文本刊更多论文

混合型导管内乳头状黏液性肿瘤在影像学上显示胰腺主管病变的频率是多少？

目的：胰腺囊肿直径≥5mm，与扩张的主胰管（MPD）连通，影像学≥5mm，定义为混合型导管内乳头状粘液瘤（MX-IPMN）。然而，MX-IPMN中MPD累及肿瘤的频率尚不清楚。本研究探讨了MX-IPMNs累及MPD的频率，以及MPD累及是否可以通过经口胰镜（POPS）诊断。方法：本回顾性队列研究纳入了2018年7月至2021年12月期间因MX-IPMN接受持久性有机污染物治疗并手术切除的患者。我们分析了MX-IPMN的病理特征，包括肿瘤向MPD的扩展。此外，评估了各种成像方式在检测肿瘤向MPD扩展方面的诊断性能。结果：15例患者中，10例（67%）病理证实肿瘤向MPD扩散。在大多数病理证实MPD累及的病例中，主要肿瘤诊断为高度不典型增生（60%）或浸润性癌（10%）。相反，在大多数没有MPD累及的病例中，低级别发育不良是主要病变(低级别发育不良占80%；高度不典型增生20%，浸润性癌0%)。活检前后对持久性有机污染物的诊断准确性、敏感性和特异性分别为93.3%、90.0%和100%。与计算机断层扫描、磁共振胰胆管造影和超声内镜检查相比，POPS具有更高的准确性和灵敏度(准确率分别为93.3%、40%、60%和80%；灵敏度：分别为93.3%、10%、40%和70%)。结论：总体而言，67%的MX-IPMNs有病理证实的MPD累及。肿瘤扩展到MPD是高度可疑的恶性肿瘤，持久性有机污染物可能有助于评估MPD的累及。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.