Kwong Wilson T, Lawson Robert D, Hunt Gordon, Fehmi Syed M, Proudfoot James A, Xu Ronghui, Giap Andrew, Tang Raymond S, Gonzalez Ingrid, Krinsky Mary L, Savides Thomas J
Division of Gastroenterology, University of California San Diego Health Sciences, 9500 Gilman Drive (MC 0956), La Jolla, CA, 92093-0956, USA,
Dig Dis Sci. 2015 Sep;60(9):2800-6. doi: 10.1007/s10620-015-3679-8. Epub 2015 Apr 30.
The majority of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) are recommended for surveillance imaging based on consensus guidelines. However, growth rates that should prompt concern for malignant transformation of BD-IPMN are unknown.
To determine whether BD-IPMN growth can predict an increased risk of malignancy and define growth rates concerning for malignant BD-IPMN.
The study is a retrospective, multicenter study of suspected BD-IPMN patients undergoing imaging surveillance. All patients underwent EUS evaluation followed by surveillance imaging.
Two hundred and eighty-four patients with suspected BD-IPMN without worrisome features or high-risk stigmata were followed for a median 56 months and underwent a median of four imaging studies. Nine patients (3.2 %) developed malignant BD-IPMN. Malignant BD-IPMN grew at a faster rate (18.6 vs. 0.8 mm/year; P = 0.05) compared to benign BD-IPMN. BD-IPMN growth rate between 2 and 5 mm/year was associated with an increased risk of malignancy with hazard ratio (HR) of 11.4 (95 % CI 2.2-58.6) when compared to subjects with BD-IPMN growth rate <2 mm/year (P = 0.004). BD-IPMN growth rate ≥5 mm/year had a hazard ratio of 19.5 (95 % CI 2.4-157.8) (P = 0.005). BD-IPMN growth rate of 2 mm/year had a sensitivity of 78 %, specificity of 90 %, and accuracy of 88 % to identify malignancy. Total BD-IPMN growth was also associated with increased risk of malignancy (P = 0.003) with all malignant IPMNs growing at least 10 mm prior to cancer diagnosis.
BD-IPMN growth rates ≥2 mm/year and total growth of ≥10 mm should be considered worrisome features for BD-IPMN at increased risk of malignancy.
根据共识指南，大多数分支导管内乳头状黏液性肿瘤（BD-IPMN）建议进行监测成像。然而，BD-IPMN发生恶性转化时应引起关注的生长速度尚不清楚。
确定BD-IPMN的生长是否能预测恶性风险增加，并确定与恶性BD-IPMN相关的生长速度。
本研究是一项对接受成像监测的疑似BD-IPMN患者的回顾性多中心研究。所有患者均接受了超声内镜评估，随后进行监测成像。
284例无可疑特征或高危征象的疑似BD-IPMN患者，中位随访时间为56个月，中位接受了4次成像检查。9例（3.2%）患者发生了恶性BD-IPMN。与良性BD-IPMN相比，恶性BD-IPMN生长速度更快（18.6 vs. 0.8 mm/年；P = 0.05）。与BD-IPMN生长速度<2 mm/年的受试者相比，BD-IPMN生长速度在2至5 mm/年之间与恶性风险增加相关，风险比（HR）为11.4（95%CI 2.2-58.6）（P = 0.004）。BD-IPMN生长速度≥5 mm/年的风险比为19.5（95%CI 2.4-157.8）（P = 0.005）。BD-IPMN生长速度为2 mm/年时，识别恶性肿瘤的敏感性为78%，特异性为90%，准确性为88%。BD-IPMN的总生长也与恶性风险增加相关（P = 0.003），所有恶性IPMN在癌症诊断前至少生长10 mm。
BD-IPMN生长速度≥2 mm/年且总生长≥10 mm应被视为恶性风险增加的BD-IPMN的可疑特征。
