Annals of Surgery

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Annals of Surgery:
doi: 10.1097/SLA.0b013e31829385f7

Imaging Features to Distinguish Malignant and Benign Branch-Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Meta-analysis

Kim, Kyung Won MD, PhD*,†; Park, Seong Ho MD, PhD*; Pyo, Junhee MS; Yoon, Soon Ho MD§; Byun, Jae Ho MD*; Lee, Moon-Gyu MD*; Krajewski, Katherine M. MD; Ramaiya, Nikhil H. MD

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Objective: To systematically determine the imaging findings for distinguishing malignant and benign branch-duct type intraductal papillary mucinous neoplasms (BD-IPMNs), including mixed type, and their diagnostic value through meta-analysis of published studies.

Background: Management of BD-IPMNs, including mixed type, largely relies on imaging findings. The current knowledge on imaging findings to distinguish malignant and benign BD-IPMNs has weak evidence and is mostly from scattered individual retrospective studies.

Methods: Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies where findings of computed tomography, magnetic resonance imaging, and endoscopic ultrasonography of BD-IPMNs with or without main pancreatic duct (MPD) dilatation were correlated with surgical/pathological findings. Review of 1128 article candidates, including full-text review of 102 articles, identified 23 eligible articles with a total of 1373 patients for meta-analysis. Dichotomous data regarding distinction between malignant and benign BD-IPMNs were pooled using random effects model to obtain the diagnostic odds ratios (DORs) and their 95% confidence intervals (CIs) of various individual imaging findings for diagnosing malignant BD-IPMN.

Results: Presence of mural nodules revealed the highest pooled DOR (95% CI) of 6.0 (4.1–8.8) followed by MPD dilatation [3.4 (2.3–5.2)], thick septum/wall [unadjusted, 3.3 (1.5–6.9); publication bias-adjusted, 2.3 (0.9–5.5)], and cyst size greater than 3 cm [2.3 (1.5–3.5)]. Multilocularity and multiplicity of the cystic lesions did not reveal statistically significant association with malignancy.

Conclusions: Presence of mural nodules should be regarded highly suspicious for malignancy warranting a surgical excision whereas cyst size greater than 3 cm, MPD dilatation (5–9 mm), or thick septum/wall may better be managed by careful observation and/or further evaluation.

© 2014 by Lippincott Williams & Wilkins.


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