Introduction
Surgical criteria for pancreatic cyst lesions are determined by the nodule in the cyst and dilation of the main pancreatic duct, but other imaging factors are needed to improve accuracy.
Aims & Methods
Aims: The present study aimed to identify factors of malignancy resection in intraductal papillary mucinous neoplasms (IPMN) treated at our center by evaluating the malignant portions of resected specimens pathologically to extract new imaging features that may serve as novel indices of malignancy.
Methods: Forty-eight patients with IPMN (14 pancreatic head, 31 body to tail, three total pancreatectomies) with a median age of 71 years (range: 38-84) and a male: female ratio of 35: 13 were enrolled. IPMN was divisible into the main pancreatic duct (n=11), branched duct (n=23), and mixed (n=14) types. Furthermore, 27, ten, and 11 cases of IPMA, high-grade IPMN (HG), and IPMC invasive group (C), respectively, were analyzed. [1] Clinical images of the benign group (A) were compared with those of the malignant group (HG+C) [2]the malignant specimens and areas of invasion were pathologically analyzed (HG+C). [3] The malignancy detection rate on DW-MRI was then examined; a higher intensity in the lesion than in the surrounding pancreatic parenchyma indicated positivity.
Results
[1] Age (median: 69 years vs. 73 years; P=0.06), history of pancreatitis (15% vs. 10%; P=0.68), and the preoperative serum mean AMY, CA19-9, and CEA positivity rates did not differ significantly between the benign and malignant groups. HbA1c (mean,%) was higher in the malignant group at 5.9 vs. 6.7 (P=0.03). In terms of imaging features, the proportion of main pancreatic ducts with a diameter >10 mm was 22% and 48% in the respective group (P=0.06); the mean cyst diameter was 33 mm vs. 28 mm (P=0.19); the proportion of contrast-enhanced nodules > 5 mm was 7.4% vs. 52.4% (P<0.01); the positivity rate on DW-MRI was 12% vs. 68% (P<0.01), the detection rate of pancreatic duct stenosis rate on MRI was 11% vs. 38% (P<0.05); worrisome features (WSF) were found in 42% (20/48) of cases; and high-risk stigmata (HRS) were found in 52% (25/48) of cases. The malignancy rate in the WSF and HRS cases was 20% (4/20) and 68% (17/25), respectively.
[ 2] The histological subtypes of the malignant group were gastric (n=5), intestinal (n=8), oncocytic (n=6), and biliary pancreatic (n=2). Areas of high-grade dysplasia and invasion in the HG group and C group, respectively, were consistent with the presence of a nodule and area of pancreatic duct stenosis.
[ 3] When instances of malignancy were treated as positive, the sensitivity, specificity, positive predictive value, negative predictive value, and positive diagnostic value of HRS was 81%, 70%, 68%, 83%, and 75%, respectively, in the 44 cases while the diagnostic performance of DW-MRI was 68%, 88%, 81%, 79%, and 80% for the respective items. The positivity rate for groups A, HG, and C was 12%, 60%, and 78%, respectively.
Conclusion
The present study of resected IPMN found that DW-MRI provided surgical criteria with a diagnostic performance comparable to the HRS criteria.