Detailed Abstract
[Poster Presentation]
[BP PP 1-4] Prediction of malignancy in Main-Duct Intraductal Papillary Mucinous Neoplasm (MD-IPMN) based on radiologic features: How should we treat if main duct dilatation is under 10 mm?
Hye sol JUNG, Youngmin HAN, Jae Seung KANG, Yoo Jin CHOI, Heeju SOHN, Jung Min LEE, Hongbeom KIM, Wooil KWON, Jin-Young JANG*
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Korea
Introduction : Surgical indications of MD-IPMN except for main pancreatic duct (MPD) diameter≥10mm remain controversial. Diameter of MPD alone could result in overestimation of malignancy. We aimed to predict malignancy risk of MD-IPMN based on morphologic features presented in CT scan or MRI.
Methods : We retrospectively reviewed 258 patients with main-duct or mixed-type IPMN between 2000 and 2017 in our institute. MD-IPMN is defined as segmental or diffuse dilatation of MPD>5mm without other causes of obstruction. We divided MD-IPMN into focal ectatic and diffuse type by pattern of dilated MPD.
Results : Of 258 patients with main-duct involved IPMN, 47(18.2%) and 211(81.8%) had main-duct and mixed-type IPMN. Risk of malignant (high-grade dysplasia(HGD)+invasive lesion)(66.0%vs46.9%, p=0.018) and invasive IPMN(53.2%vs26.1%, p<0.001) were higher in MD-IPMN than mixed-type. Patients with MPD≥10mm(n=100) had more malignant(64.0% vs 41.8%, p<0.001) and invasive(43.0%vs23.4%, p<0.001) lesion than those with MPD 5-9mm(n=158). Of 47 patients with MD-IPMN, focal ectatic and diffuse type were presented in 27(57.4%), and 20(42.6%). 43(91.5%) patients showed MPD≥10mm. Mean MPD diameter(maximal) was 17.4±12.2mm in MD-IPMN group. Diffuse type had more invasive carcinoma compared with focal ectatic type (70%vs40.7%, p=0.047). 5-year survival was worse in diffuse type (85.0%vs52.1%, p=0.011). Focal ectatic MD-IPMN and mixed-type IPMN did not significantly differ in risk of malignant(55.6% vs 47.4%, p=0.425) lesion and in 5-year survival(85.0%vs77.6%, p=0.995). Symptoms(p=0.011), CA19-9>37IU/ml(p=0.014), MPD≥10mm(p=0.017), thickened cyst wall(p=0.005), and distal atrophy(p=0.015) were independent predictive factors for malignant IPMN.
Conclusions : Malignancy risk increased proportionally to the diameter of MPD in MD-IPMN. Those with above mentioned risk factors should be the candidate of surgery.
Methods : We retrospectively reviewed 258 patients with main-duct or mixed-type IPMN between 2000 and 2017 in our institute. MD-IPMN is defined as segmental or diffuse dilatation of MPD>5mm without other causes of obstruction. We divided MD-IPMN into focal ectatic and diffuse type by pattern of dilated MPD.
Results : Of 258 patients with main-duct involved IPMN, 47(18.2%) and 211(81.8%) had main-duct and mixed-type IPMN. Risk of malignant (high-grade dysplasia(HGD)+invasive lesion)(66.0%vs46.9%, p=0.018) and invasive IPMN(53.2%vs26.1%, p<0.001) were higher in MD-IPMN than mixed-type. Patients with MPD≥10mm(n=100) had more malignant(64.0% vs 41.8%, p<0.001) and invasive(43.0%vs23.4%, p<0.001) lesion than those with MPD 5-9mm(n=158). Of 47 patients with MD-IPMN, focal ectatic and diffuse type were presented in 27(57.4%), and 20(42.6%). 43(91.5%) patients showed MPD≥10mm. Mean MPD diameter(maximal) was 17.4±12.2mm in MD-IPMN group. Diffuse type had more invasive carcinoma compared with focal ectatic type (70%vs40.7%, p=0.047). 5-year survival was worse in diffuse type (85.0%vs52.1%, p=0.011). Focal ectatic MD-IPMN and mixed-type IPMN did not significantly differ in risk of malignant(55.6% vs 47.4%, p=0.425) lesion and in 5-year survival(85.0%vs77.6%, p=0.995). Symptoms(p=0.011), CA19-9>37IU/ml(p=0.014), MPD≥10mm(p=0.017), thickened cyst wall(p=0.005), and distal atrophy(p=0.015) were independent predictive factors for malignant IPMN.
Conclusions : Malignancy risk increased proportionally to the diameter of MPD in MD-IPMN. Those with above mentioned risk factors should be the candidate of surgery.
SESSION
Poster Presentation
E-Session 3/25 ~ 3/27 ALL DAY