Main pancreatic duct dilation greater than 6 mm is associated with an increased risk of high-grade dysplasia and cancer in IPMN patients

  • Zeeshan Ateeb
  • Roberto Valente
  • Raffaella M. Pozzi-Mucelli
  • Linnéa Malgerud
  • Yasmine Schlieper
  • Elena Rangelova
  • Carlos Fernandez-Moro
  • Johannes Matthias Löhr
  • Urban Arnelo
  • Marco Del ChiaroEmail author



IPMNs, considered precursor lesions of pancreatic adenocarcinoma (PDAC), might display histological alteration varying from low-grade dysplasia (LGD) to cancer. Nevertheless, the prevalence of PDAC is far below the prevalence of IPMN; therefore, not all of these precursor lesions finally progress to cancer. Preoperative features consistent with and finding at final histology of high-grade dysplasia (HGD) or cancer are currently lacking. The aim of this study is to correlate the presence of preoperative clinical features with the finding of advance lesions at final histology.


This is retrospective cohort analysis of patients who underwent surgery for histologically confirmed IPMNs at Karolinska University Hospital, from 2008 to 2015.


MPD 6–9.9 mm and ≥ 10 mm were associated with an increased risk of HGD/cancer (respectively, OR 2.92, CI 1.38–6.20, p = 0.005 and OR 2.65, CI 1.12–6.25, p = 0.02). Preoperative high CA19.9 and jaundice were both associated with a higher risk of HGD/cancer at final histology (respectively, OR 4.15, CI 1.90–9.05, p = 0.0003 and OR 15.36, CI 1.94–121.22, p = 0.009). At sex- and age-adjusted multivariable logistic regression analysis, MPD between 6 and 9.9 mm (OR 2.64, CI 1.15–6.06, p = 0.02), jaundice (OR 12.43, CI 1.44–106.93, p = 0.02), and elevated CA19.9 (OR 3.71, CI 1.63–8.46, p = 0.001) remained associated with the occurrence of HGD/cancer.


The presence of MPD dilation ≥ 6 mm, jaundice, and elevated CA19.9 in IPMN patients are consistent with the finding for HGD/cancer at final histology, thus representing possible markers of advanced lesions suitable for earlier or preventive curative surgical treatment.


Intraductal papillary mucinous neoplasms of the pancreas (IPMN) Pancreas cancer prevention Early diagnosis Pancreas surgery Pancreatic cystic tumors 


Author’s contributions

Zeeshan Ateeb collected the data and contributed to write the manuscript. Roberto Valente contributed to write the manuscript and performed the statistical analysis. Yasmine Schlieper contributed to collect data. Carlos Fernaned Moro revised the patient’s histology. Raffaella M. Pozzi-Mucelli revised the patient’s radiological files. Linnea Malgerud, Elena Rangelova, Johannes Matthias Löhr, and Urban Arnelo critically revised the manuscript. Marco Del Chiaro was responsible of the study design and contributed to write the paper.


The present study was supported by Cancerfonden, Sweden (CAN 2014/634 and CAN 2014/621) and ALF Medicine (2016 #20150113).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained by the local ethical committee (EPN 2015/1544–31/4).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Zeeshan Ateeb
    • 1
  • Roberto Valente
    • 1
    • 2
  • Raffaella M. Pozzi-Mucelli
    • 3
  • Linnéa Malgerud
    • 1
  • Yasmine Schlieper
    • 1
  • Elena Rangelova
    • 1
  • Carlos Fernandez-Moro
    • 4
  • Johannes Matthias Löhr
    • 1
  • Urban Arnelo
    • 1
  • Marco Del Chiaro
    • 1
    • 5
  1. 1.Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention, and TechnologyKarolinska InstitutetStockholmSweden
  2. 2.Digestive and Liver Diseases UnitSapienza University of RomeRomeItaly
  3. 3.Division of Radiology, Department of Clinical Science, Intervention, and TechnologyKarolinska InstitutetStockholmSweden
  4. 4.Division of Pathology, Department of Laboratory MedicineKarolinska InstitutetStockholmSweden
  5. 5.Division of Surgical Oncology, Department of SurgeryUniversity of Colorado Anschutz Medical CampusAuroraUSA

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