Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;275(6):e789-e795.
doi: 10.1097/SLA.0000000000004307. Epub 2020 Nov 12.

Significance of Uncinate Duct Dilatation in IPMNs: A New High-risk Criterion?

Samer S AlMasri  1 , Mazen S Zenati  2 , Anil Dasyam  3 , Aatur D Singhi  4 , Kenneth K Lee  1 , David L Bartlett  1 , Adam Slivka  5 , Kevin Mcgrath  5 , Jennifer Chennat  5 , Kenneth E Fasanella  5 , Asif Khalid  5 , Randall E Brand  5 , Savreet Sarkaria  5 , Rohit Das  5 , Melissa E Hogg  6 , Herbert J Zeh  7 , Alessandro Paniccia  1 , Amer H Zureikat  1
Affiliations

Significance of Uncinate Duct Dilatation in IPMNs: A New High-risk Criterion?

Samer S AlMasri et al. Ann Surg. .

Abstract

Objective: To evaluate the significance of UDD in IPMNs.

Background: The uncinate process of the pancreas has an independent ductal drainage system. International consensus guidelines of IPMNs still consider it as a branch-duct, even though it is the main drainage system for the uncinate process.

Methods: A retrospective review of all surgically treated IPMNs at our institution after 2008 was performed. Preoperative radiological studies were reviewed by an abdominal radiologist who was blinded to the pathological results. In addition to the Fukuoka criteria, presence of UDD was recorded. Using multivariate analysis, the pathological significance of UDD in predicting advanced neoplasia [high grade dysplasia or invasive carcinoma (HGD/ IC)] was determined.

Results: Two hundred sixty patients were identified (mean age at diagnosis was 68 years and 49% were females): 122 (47%) had HGD/IC. UDD was noted in 59 (23%), of which 36 (61%) had HGD/IC (P < 0.003). On multivariate analysis, UDD was an independent predictor of HGD/IC (odds ratio = 2.99, P < 0.04). Subgroup analysis on patients with IPMNs confined to the dorsal portion of the gland (n = 161), also demonstrated UDD to be a significant predictor of HGD/IC in those remote lesions (odds ratio: 4.41, P = 0.039).

Conclusions: This is the largest study to evaluate the significance of UDD in IPMNs and shows it to be a high-risk feature. This association persisted for remote IPMNs limited to the dorsal pancreas, suggesting UDD may be associated with an aggressive phenotype even in remote IPMN lesions.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interests to disclose.

References

    1. Ban S, Naitoh Y, Mino-Kenudson M, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol 2006; 30:1561–1569.
    1. Fonseca A, Kirkwood K, Kim M, et al. Intraductal papillary mucinous neoplasms of the pancreas. Pancreas 2018; 47:272–279.
    1. Kaimakliotis P, riff B, Pourmand K, et al. Sendai and Fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol 2015; 13:1808–1815.
    1. Crippa S, Bassi C, Salvia R, et al. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut 2017; 66:495–506.
    1. Hsiao C, Yang C, Wu J, et al. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Medicine 2016; 95:e4922.