Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients
Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients
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DOI：
10.1111/j.1572-0241.2007.01224.x
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发表时间：
2007-08-01
影响因子：
9.8
通讯作者：
Farnell, Michael B.
中科院分区：
文献类型：
--
作者：
Pelaez-Luna, Mario;Chari, Suresh T.;Farnell, Michael B.
背景和目标：最近的共识指南建议，存在以下情况之一以上者是分支导管内乳头状粘液性肿瘤（IPMN-Br）切除（IR）的指征：囊肿相关症状、主胰管直径≥ 10 mm、囊肿大小≥ 30 mm、壁内结节或囊液细胞学检查疑似恶性肿瘤/阳性。在IPMN-Br的患者队列中，我们确定了是否共识IR（CIR），存在多灶性IPMN-Br，或后续预测malignancy.Methods囊肿大小的增长：我们确定了147例IPMN-Br的66人进行手术切除在诊断和81保守，其中11人在随访期间切除。所有147例IPMN-Br患者的临床、影像学、组织学和囊液特征均来自临床记录和/或联系患者。在所有病例中，观察到基线和随访期间存在CIR（N = 66）、存在多灶性囊肿（N = 57）以及囊肿大小增加（N = 38）。结果：在77例切除的IPMN-Brs中，在初步评估时，61例至少有一次CIR，16例没有。在9/61例（15%）有CIR的患者和0/16例无IR的患者中，存在胰岛素抵抗（P = 0.1）。当存在任何一种CIR作为恶性肿瘤的指标时，CIR的敏感性、特异性、阳性预测值和阴性预测值分别为100%、23%、14%和100%。单灶性与多灶性IPMN-Br患者的恶性肿瘤患病率相似（13% vs 11%）。在中位随访15个月后，没有患者发生恶性肿瘤。到目前为止，没有38例囊肿大小增加随访恶性肿瘤相关的symptoms.Conclusions：建议共识切除术的适应症确定所有恶性肿瘤患者，但是，他们的特异性低。在短期内，跟踪没有这些特征的患者是安全的。
Background and aims: Recent consensus guidelines suggest that presence of >= 1 of the following is an indication for resection (IR) of branch duct intraductal papillary mucinous neoplasm (IPMN-Br): cyst-related symptoms, main pancreatic duct diameter >= 10 mm, cyst size >= 30 mm, intramural nodules, or cyst fluid cytology suspicious/positive for malignancy. Among a cohort of patients with IPMN-Br we determined if the consensus IR (CIR), presence of multifocal IPMN-Br, or growth of cyst size on follow-up predict malignancy.Methods: We identified 147 patients with IPMN-Br of whom 66 underwent surgical resection at diagnosis and 81 were followed conservatively, of whom 11 were resected during follow-up. Clinical, imaging, histological, and cyst fluid characteristics from all 147 patients with IPMN-Br were obtained from clinical records and/or by contacting the patients. In all cases, presence of CIR at baseline and during follow-up (N = 66), presence of multifocal cysts (N = 57), and increase in cyst size (N = 38) were noted.Results: Among the 77 resected IPMN-Brs, at initial evaluation 61 had at least one CIR and 16 had none. Malignancy was present in 9/61 (15%) with CIR and 0/16 without IR (P = 0.1). When presence of any one of the CIR was taken as an indicator of malignancy, the CIR had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 23%, 14%, and 100%, respectively. Prevalence of malignancy in those with single versus multifocal IPMN-Br was similar (13% vs 11%). No patient has developed malignancy after a median follow-up of 15 months. So far, none of the 38 patients with increase in cyst size on follow-up has developed malignancy related symptoms.Conclusions: Suggested consensus indications for resection identify all patients with malignancy; however, their specificity is low. In the short term it would be safe to follow patients without these features.