Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka 537-8511, Japan.
J Gastroenterol. 2011 May;46(5):657-63. doi: 10.1007/s00535-010-0343-0. Epub 2010 Nov 18.
A mural nodule is a strong predictive factor for malignancy in branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas, but the nodule size has hardly been considered. The aim of this study was to investigate whether a mural nodule of 10 mm was appropriate as an indicator of surgery for IPMN during follow-up.
The follow-up outcomes of 100 patients who had branch duct IPMN without mural nodules or who had branch duct IPMN with mural nodules of less than 9 mm in a tertiary care setting were investigated retrospectively. The patients underwent abdominal ultrasound (US) every 3 months and additional imaging examinations or cytologic examination of pancreatic juice when necessary. Surgery was recommended to them when a mural nodule developed or when a nodule enlarged and reached 10 mm.
During an average follow-up period of 97 months, branch duct IPMNs developed mural nodules that reached 10 mm in 5 patients (0.62% per year). In one patient the IPMN was revealed to be non-invasive carcinoma by resection, 1 IPMN was shown to be malignant by further follow-up, and 3 were not resected because of refusal or the patient's age. In 7 patients, mural nodules stayed within 9 mm. The remaining 88 patients lacked mural nodules in their branch duct IPMNs throughout the follow-up. The occurrence of invasive carcinoma around the IPMN was not indicated by imaging examinations in any patient. Univariate analysis showed that the size of the cyst at baseline significantly predicted the development of a mural nodule that reached 10 mm during follow-up (P = 0.05).
A mural nodule of 10 mm is appropriate as an indicator of surgery in the follow-up of branch duct IPMN.
壁结节是胰腺分支胰管内乳头状黏液性肿瘤（IPMN）发生恶性肿瘤的一个强有力的预测因素，但很少考虑结节的大小。本研究旨在探讨在随访过程中，壁结节大小为 10mm 是否适合作为手术治疗 IPMN 的指标。
回顾性分析了在一家三级医疗机构中，无壁结节的分支胰管 IPMN 或分支胰管 IPMN 伴壁结节小于 9mm 的 100 例患者的随访结果。这些患者接受了腹部超声（US）每 3 个月检查，如果需要，还进行了额外的影像学检查或胰液细胞学检查。当出现壁结节或结节增大至 10mm 时，建议他们进行手术。
在平均 97 个月的随访期间，5 例患者（0.62%/年）的分支胰管 IPMN 发展为壁结节且达到 10mm。其中 1 例患者因切除而发现 IPMN 为非浸润性癌，1 例患者经进一步随访证实为恶性，3 例患者因拒绝或患者年龄原因未进行切除。在 7 例患者中，壁结节保持在 9mm 以内。其余 88 例患者在整个随访期间其分支胰管 IPMN 均无壁结节。在任何患者中，影像学检查均未提示 IPMN 周围发生浸润性癌。单因素分析显示，基线时囊肿的大小显著预测了在随访过程中壁结节发展至 10mm（P=0.05）。
壁结节大小为 10mm 适合作为分支胰管 IPMN 随访过程中手术的指标。
