Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China.
BMC Gastroenterol. 2022 Nov 19;22(1):473. doi: 10.1186/s12876-022-02577-3.
Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD diameter in predicting malignancy may be related to the lesion location. This study aimed to separately identify the thresholds of MPD for malignancy of IPMNs separately for the head-neck and body-tail.
A total of 185 patients with pathologically confirmed IPMNs were included. Patient demographic information, clinical data, and pathological features were obtained from the medical records. Those IPMNs with high-grade dysplasia or with associated invasive carcinoma were considered as malignant tumor. Radiological data including lesion location, tumor size, diameter of the MPD, mural nodule, and IPMN types (main duct, MD; branch duct, BD; and mixed type, MT), were collected on computed tomography or magnetic resonance imaging. Serum carbohydrate antigen 19-9 levels, serum carcinoembryonic antigen levels, and the medical history of diabetes mellitus, chronic cholecystitis, and pancreatitis were also collected.
Malignant IPMNs were detected in 31.6% of 117 patients with lesions in the pancreatic head-neck and 20.9% of 67 patients with lesions in the pancreatic body-tail. In MPD-involved IPMNs, malignancy was observed in 54.1% of patients with lesions in the pancreatic head-neck and 30.8% of patients with lesions in the pancreatic body-tail (p < 0.05). The cutoff value of MPD diameter for malignancy was 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail in all type of IPMNs. In MPD-involved IPMNs, the threshold was 8.2 mm for lesion in pancreatic head-neck and 7.7 mm for lesions in the body-tail. Multivariate analysis confirmed that MPD diameter ≥ 6.5 mm (pancreatic head-neck) and MPD diameter ≥ 7.7 mm (pancreatic body-tail) were independent predictors of malignancy (p < 0.05). Similar results were observed in MPD-involved IPMNs using 8.2 mm as a threshold.
The thresholds of the dilated MPD may be associated with IPMNs locations. Thresholds of 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail were observed. For MPD-involved IPMNs alone, threshold for lesions in the head-neck was close to that in the body-tail.
主胰管（MPD）扩张是胰管内乳头状黏液性肿瘤（IPMN）中恶性肿瘤的高风险特征/令人担忧的特征。预测恶性肿瘤的 MPD 直径阈值可能与病变位置有关。本研究旨在分别确定胰头颈部和体尾部 IPMN 恶性肿瘤的 MPD 直径阈值。
共纳入 185 例经病理证实的 IPMN 患者。从病历中获取患者的人口统计学信息、临床资料和病理特征。高级别异型增生或伴浸润性癌的 IPMN 被认为是恶性肿瘤。收集 CT 或 MRI 上的影像学数据，包括病变位置、肿瘤大小、MPD 直径、壁结节和 IPMN 类型（主胰管、MD；分支胰管、BD；混合类型、MT）。还收集血清糖抗原 19-9 水平、血清癌胚抗原水平以及糖尿病、慢性胆囊炎和胰腺炎的病史。
在 117 例胰头颈部病变患者中，恶性 IPMN 占 31.6%，67 例胰体尾部病变患者中，恶性 IPMN 占 20.9%。在 MPD 受累的 IPMN 中，胰头颈部病变患者中恶性肿瘤占 54.1%，胰体尾部病变患者中恶性肿瘤占 30.8%（p<0.05）。在所有类型的 IPMN 中，MPD 直径用于诊断恶性肿瘤的截断值在胰头颈部病变为 6.5mm，在胰体尾部病变为 7.7mm。在 MPD 受累的 IPMN 中，胰头颈部病变的阈值为 8.2mm，胰体尾部病变的阈值为 7.7mm。多因素分析证实 MPD 直径≥6.5mm（胰头颈部）和 MPD 直径≥7.7mm（胰体尾部）是恶性肿瘤的独立预测因子（p<0.05）。在使用 8.2mm 作为阈值时，MPD 受累的 IPMN 也观察到类似的结果。
扩张的 MPD 阈值可能与 IPMN 的位置有关。观察到胰头颈部病变的阈值为 6.5mm，胰体尾部病变的阈值为 7.7mm。对于单独的 MPD 受累的 IPMN，胰头颈部病变的阈值接近胰体尾部病变。
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