Cytological and cyst fluid analysis of small (≤3 cm) branch duct intraductal papillary mucinous neoplasms adds value to patient management decisions
Cytological and cyst fluid analysis of small (≤3 cm) branch duct intraductal papillary mucinous neoplasms adds value to patient management decisions
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DOI：
10.1159/000134276
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发表时间：
2008-01-01
期刊：
影响因子：
3.6
通讯作者：
Bounds, Brenna C.
中科院分区：
文献类型：
--
作者：
Pitman, Martha Bishop;Michaels, Paul J.;Bounds, Brenna C.
背景/目的：小（1-3 cm）分支导管内乳头状黏液性肿瘤（IPMN）患者的治疗是一项挑战。症状、扩张的导管、壁结节或阳性细胞学已被建议作为切除的参数。我们的研究的目的是比较这种算法，结合细胞学与小于恶性上皮细胞和囊液癌胚抗原（CEA）。方法：采用回顾性研究。结果：良性囊肿14例，恶性囊肿6例，其中3例为侵袭性囊肿。无一例与导管扩张相关，无一例细胞学阳性。通过单变量分析，只有壁结节对恶性肿瘤（p = 0.01）和浸润（p = 0.009）的检测具有显著性。检测非典型上皮细胞或12，500 ng/ml的囊液CEA对于恶性肿瘤的检测比使用推荐算法更准确。结论：单因素分析显示，小分支导管IPMN中存在壁结节是恶性肿瘤和浸润的预测因子。与阳性细胞学或12，500 ng/ml的囊液CEA相比，识别非典型上皮细胞成分比推荐算法更准确，并且增加了临床诊断的小分支导管IPMN的术前评估价值。版权所有（c）2008 S. Karger AG、巴塞尔和IAP。
Background/Aim: Management of patients with small (1-3 cm) branch duct intraductal papillary mucinous neoplasms (IPMN) is a challenge. Symptoms, dilated duct, mural nodule or positive cytology have been proposed as parameters for resection. The aim of our study was to compare this proposed algorithm to one that incorporates cytology with less than malignant epithelial cells and cyst fluid carcinoembryonic antigen (CEA). Methods: A retrospective study was conducted. Results: There were 14 nonmalignant and 6 malignant cysts with 3 invasive IPMN. None were associated with a dilated duct and none had positive cytology. Only a mural nodule was significant by univariate analysis for the detection of malignancy (p = 0.01) and invasion (p = 0.009). The detection of atypical epithelial cells or a cyst fluid CEA of 1 2,500 ng/ml was more accurate for the detection of malignancy than using the recommended algorithm. Conclusions: The presence of a mural nodule in a small branch duct IPMN is a predictor of malignancy and invasion by univariate analysis. Recognition of an atypical epithelial cell component in contrast to positive cytology or a cyst fluid CEA of 1 2,500 ng/ml is more accurate than the recommended algorithm and adds value to the preoperative assessment of clinically diagnosed small branch duct IPMN. Copyright (c) 2008 S. Karger AG, Basel and IAP.