Predicting malignant intraductal papillary mucinous neoplasm: a single-center review

Abstract

Background: The purpose of this study was to examine the characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) in our institution and the selection for resection. Recent publications, including those from the International Consensus Guidelines and the Mayo Clinic, set forth criteria for resection. However, these criteria differ in the definition of main duct IPMN, which is an indication to resect.

Methods: Sixty patients from a single institution were retrospectively reviewed between 2000 and 2009.

Results: Thirteen percent of patients had high-grade dysplasia, and 22% had invasive cancer. In multivariate analysis, factors associated with a lower risk of carcinoma were female sex (P = .039) and size <3 cm (P = .024). Patients were retrospectively evaluated with Mayo and International Consensus Guidelines. Eight patients had a diagnosis that would have changed from main duct to branch duct if the International Consensus Guidelines were used. Of these 8, there were 2 cancers. If the International Consensus Guidelines were applied instead of the Mayo, both cancers would have been resected, but 2 patients without cancer would have been spared an operation.

Conclusions: Twenty-two percent of resected patients had invasive cancer, and they had significantly worse survival (37 vs 85 months, P = .032). In our patient group, application of the International Consensus Guidelines identified all malignant IPMN and would have prevented 2 nontherapeutic resections when compared with the Mayo criteria.