我们是否应将所有主胰管型胰腺导管内乳头状黏液性肿瘤（MD-IPMN）视为手术指征？-一项回顾性研究，纳入 29 例存在壁结节的 MD-IPMN 患者。
Should we regard all main duct type intraductal papillary mucinous neoplasms of the pancreas (MD-IPMN) as an indication of surgery? -A retrospective study in 29 patients with MD-IPMN showing mural nodules.
机构信息
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
出版信息
Pancreatology. 2019 Mar;19(2):352-359. doi: 10.1016/j.pan.2019.01.005. Epub 2019 Jan 11.
PURPOSE
To elucidate predictive factors for malignant main duct type IPMN (MD-IPMN).
METHODS
All 29 subjects had mural nodules (MNs) in the main pancreatic duct (MPD) on preoperative endoscopic ultrasonography and underwent surgery (19, malignant; 10, benign). Possible predictive factors for malignancy such as background, imaging, and histological factors including histological subtype (HS), were evaluated.
RESULTS
Multivariate analysis revealed an MPD diameter of ≥12 mm (p = 0.042) and non-gastric type (p = 0.001) to be the statistically significant predictive factors for malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to detect malignancy by using "an MPD diameter of ≥12 mm and/or non-gastric type" were 95%, 70%, 86%, 88%, and 86%, respectively. In 7 subjects in whom HS was preoperatively evaluated using pancreatic specimens obtained before surgery, the agreement rate of the preoperative HS with definitive HS evaluated using resected specimens was 86%.
CONCLUSIONS
For MD-IPMNs with MNs, "an MPD diameter of ≥12 mm and/or non-gastric type" are indicated for surgery. On the other hand, careful surveillance without immediate pancreatic surgery may be an option for MD-IPMNs showing both an MPD diameter of <12 mm and gastric type.
目的
阐明恶性主胰管型 IPMN（MD-IPMN）的预测因素。
方法
所有 29 例患者术前内镜超声检查均显示主胰管（MPD）有壁结节（MNs），并接受了手术治疗（19 例恶性，10 例良性）。评估了可能的预测因素，如背景、影像学和组织学因素，包括组织学分型（HS）。
结果
多变量分析显示 MPD 直径≥12mm（p=0.042）和非胃型（p=0.001）是恶性的统计学显著预测因素。使用“MPD 直径≥12mm 和/或非胃型”检测恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为 95%、70%、86%、88%和 86%。在 7 例术前使用手术前获得的胰腺标本评估 HS 的患者中，术前 HS 与使用切除标本评估的明确 HS 的一致性率为 86%。
结论
对于有 MN 的 MD-IPMN，“MPD 直径≥12mm 和/或非胃型”提示手术。另一方面，对于 MPD 直径<12mm 且呈胃型的 MD-IPMN，可选择密切监测而不立即进行胰腺手术。
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