Annals of Surgery

Skip Navigation LinksHome > October 2007 - Volume 246 - Issue 4 > Intraductal Papillary Mucinous Neoplasms: Predictors of Mali...
Annals of Surgery:
doi: 10.1097/SLA.0b013e318155a9e5
Original Articles

Intraductal Papillary Mucinous Neoplasms: Predictors of Malignant and Invasive Pathology

Schmidt, C Max MD, PhD, MBA, FACS; White, Patrick B. MD; Waters, Joshua A. MD; Yiannoutsos, Constantin T. PhD; Cummings, Oscar W. MD; Baker, Marshall MD; Howard, Thomas J. MD; Zyromski, Nicholas J. MD; Nakeeb, Atilla MD; DeWitt, John M. MD; Akisik, Fatih M. MD; Sherman, Stuart MD; Pitt, Henry A. MD; Lillemoe, Keith D. MD

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Objective: Determine whether size and other preoperative parameters predict malignant or invasive intraductal papillary mucinous neoplasia (IPMN).

Summary Background Data: From 1991 to 2006, 150 patients underwent 156 operations for IPMN.

Methods: Prospectively collected, retrospective review of a single academic institution's experience. All preoperative parameters including a detailed radiologic-based classification of IPMN type, location, distribution, size, number, cytology, and mural nodularity were correlated with IPMN pathology.

Results: Malignant IPMN was present in 32% of cases, whereas 19% of cases were invasive. IPMN type and main pancreatic duct diameter were significant predictors of malignant IPMN (P < 0.001). Side-branch lesion number was negatively associated with invasive IPMN (P = 0.03). Side-branch size, location, and distribution did not predict IPMN pathology. The presence of mural nodules was associated with malignant and invasive IPMN (P < 0.001; P < 0.02). Atypical cytopathology was significantly associated with malignant and invasive IPMN (P < 0.001; P < 0.001). Multivariate analysis demonstrated mural nodularity and atypical cytopathology were predictive of malignancy and/or invasion in branch-type IPMN.

Conclusions: To lower the rate of invasive pathology, surgery should be recommended for fit patients with main-duct IPMN and for branch-duct IPMN with mural nodularity or positive cytology irrespective of location, distribution, or size.

© 2007 Lippincott Williams & Wilkins, Inc.


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