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Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Patients with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) without invasion usually show favorable prognosis. However, the prognosis becomes poor when the IPMN lesions give rise to invasive carcinoma cells. In addition, recent studies have revealed that BD-IPMN is frequently complicated by common type pancreatic ductal carcinoma. Thus, the prognosis of BD-IPMN depends on the occurrence of these two types of invasive carcinoma. However, little is known about the risk factors for the development of these invasive carcinomas in BD-IPMN. This study aims to identify the factors which predict the development of invasive carcinoma in BD-IPMN.

Methods

Invasive pancreatic carcinoma associating with BD-IPMN was classified as invasive IPMN group (invasive carcinoma derived directly from IPMN lesions) and concomitant group (common type of invasive carcinoma concomitant with BD-IPMN). The relation between the incidence of each type of invasive carcinoma in BD-IPMN and the clinicopathological parameters was retrospectively analyzed.

Results

There were 12 patients with invasive IPMN and 7 patients with concomitant cancer in 159 patients with BD-IPMN. Diameter of dilated branch (P < 0.001) or main pancreatic duct (MPD) (P = 0.001), size of mural nodule (P < 0.001), serum CEA level (P < 0.001) and serum CA19-9 level (P < 0.001) were factors associated significantly with invasive IPMN by univariate analysis. Among these factors, mural nodule with size larger than 6.5 mm [odds ratio 14.86 (95% CI 1.37–60.45); P = 0.02] and serum carcinoembryonic antigen (CEA) level over 5 ng/ml [odds ratio 6.91 (95% CI 1.17–54.13); P = 0.03] were found to be the factors independently associated with invasive IPMN. On the other hand, both univariate and multivariate analyses revealed that elevated carbohydrate antigen 19-9 (CA 19-9) levels were associated with the occurrence of concomitant ductal carcinoma in BD-IPMN [odds ratio 10.31 (95% CI 1.77–81.51); P = 0.01].

Conclusions

Our results suggested that careful imaging study of the entire pancreas in addition to tumor lesions and measurement of serum CEA and CA19-9 would be required to find out the development of the two types of invasive carcinoma in BD-IPMN.

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Abbreviations

IPMN:

Intraductal papillary mucinous neoplasms

BD-IPMN:

Branch duct type intraductal papillary mucinous neoplasms

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

EUS:

Endoscopic ultrasonography

CT:

Computed tomography

MRI:

Magnet resonance imaging

ERCP:

Endoscopic retrograde cholangiopancreatography

MPD:

Main pancreatic duct

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Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan

    Atsushi Kanno, Kennichi Satoh, Morihisa Hirota, Shin Hamada, Jun Umino, Hiromichi Itoh, Atsushi Masamune, Tohru Asakura & Tooru Shimosegawa

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  1. Atsushi Kanno
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  2. Kennichi Satoh
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  3. Morihisa Hirota
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Correspondence to Kennichi Satoh.

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Kanno, A., Satoh, K., Hirota, M. et al. Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas. J Gastroenterol 45, 952–959 (2010). https://doi.org/10.1007/s00535-010-0238-0

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  • DOI: https://doi.org/10.1007/s00535-010-0238-0

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