Indiana University School of Medicine, Indianapolis, Indiana, USA; Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Gastrointest Endosc. 2016 Sep;84(3):436-45. doi: 10.1016/j.gie.2016.02.008. Epub 2016 Feb 18.
Management of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging. We determined factors associated with malignancy in BD-IPMNs and long-term outcomes.
This retrospective cohort study included all patients with established BD-IPMNs by the International Consensus Guidelines (ICG) 2012 and/or pathologically confirmed BD-IPMNs in a tertiary care referral center between 2001 and 2013. Main outcome measures were the association between high-risk stigmata (HRS)/worrisome features (WFs) of the ICG 2012 and malignant BD-IPMNs, performance characteristics of EUS-FNA for the diagnosis of malignant BD-IPMNs, and recurrence and long-term outcomes of BD-IPMN patients undergoing surgery or imaging surveillance.
Of 364 BD-IPMN patients, 229 underwent imaging surveillance and 135 underwent surgery. Among the 135 resected BD-IPMNs, HRS/WFs on CT/magnetic resonance imaging (MRI) were similar between the benign and malignant groups, but main pancreatic duct (MPD) dilation (5-9 mm) was more frequently identified in malignant lesions. On EUS-FNA, mural nodules, MPD features suspicious for involvement, and suspicious/positive malignant cytology were more frequently detected in the malignant group with a sensitivity, specificity, and accuracy of 33%, 94%, and 86%; 42%, 91%, and 83%; and 33% 91%, and 82%, respectively. Mural nodules identified by EUS were missed by CT/MRI in 28% in the malignant group. Patients with malignant lesions had a higher risk of any IPMN recurrence during a mean follow-up period of 131 months (P = .01).
Among HRS and WFs of the ICG 2012, an MPD size of 5 to 9 mm on CT/MRI was associated with malignant BD-IPMNs. EUS features including mural nodules, MPD features suspicious for involvement, and suspicious/malignant cytology were accurate and highly specific for malignant BD-IPMNs. Our study highlights the incremental value of EUS-FNA over imaging in identifying malignant BD-IPMNs, particularly in patients without WFs and those with smaller cysts. Benign IPMN recurrence was observed in some patients up to 8 years after resection.
分支胰管内乳头状黏液性肿瘤（BD-IPMNs）的管理仍然具有挑战性。我们确定了与 BD-IPMN 恶性肿瘤相关的因素以及长期预后。
本回顾性队列研究纳入了 2001 年至 2013 年间在一家三级转诊中心通过国际共识指南（ICG）2012 或病理证实为 BD-IPMN 的所有患者。主要观察指标是 ICG 2012 高危特征（HRS）/可疑特征（WFs）与恶性 BD-IPMNs 的相关性、EUS-FNA 对恶性 BD-IPMNs 的诊断性能特征，以及接受手术或影像学监测的 BD-IPMN 患者的复发和长期预后。
在 364 例 BD-IPMN 患者中，229 例接受影像学监测，135 例接受手术治疗。在 135 例切除的 BD-IPMN 中，CT/MRI 上的 HRS/WFs 在良性和恶性组之间相似，但在恶性病变中更常发现主胰管（MPD）扩张（5-9mm）。在 EUS-FNA 中，恶性组中更常发现壁结节、MPD 可疑受累特征和可疑/阳性恶性细胞学，其敏感性、特异性和准确性分别为 33%、94%和 86%；42%、91%和 83%；33%、91%和 82%。在恶性组中，EUS 发现的壁结节在 CT/MRI 中漏诊了 28%。在平均随访 131 个月期间，恶性病变患者的任何 IPMN 复发风险均较高（P=0.01）。
在 ICG 2012 的 HRS 和 WFs 中，CT/MRI 上的 MPD 大小为 5-9mm 与恶性 BD-IPMNs 相关。EUS 特征，包括壁结节、MPD 可疑受累特征和可疑/恶性细胞学，对恶性 BD-IPMNs 准确且高度特异。本研究强调了 EUS-FNA 在识别恶性 BD-IPMNs 方面优于影像学检查的附加价值，特别是在无 WFs 和囊肿较小的患者中。一些患者在切除后 8 年内仍观察到良性 IPMN 复发。
