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Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2016 Nov 21; Vol. 22 (43), pp. 9562-9570. - Publication Year :
- 2016
-
Abstract
- Aim: To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up.<br />Methods: We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata ( e.g ., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes.<br />Results: We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (< 10 mm) increase and/or decrease of cysts size at a median time of 22.5 mo. Alert findings developed in 6/72 patients (8.3%; 95%CI: 3.4-17.9) over a wide interval of time (13-63 mo). No malignancy was found on endoscopic ultrasound with fine-needle aspiration (5/6 cases) or surgery (1/6 cases). No clinical or initial MRCP features were significantly associated with changes in bd-IPMN appearance ( P > 0.01).<br />Conclusion: Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy.<br />Competing Interests: Conflict-of-interest statement: Nothing to disclose.
- Subjects :
- Adult
Aged
Aged, 80 and over
Disease Progression
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasms, Cystic, Mucinous, and Serous pathology
Pancreatic Ducts pathology
Pancreatic Neoplasms pathology
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Time Factors
Cholangiopancreatography, Magnetic Resonance
Incidental Findings
Neoplasms, Cystic, Mucinous, and Serous diagnostic imaging
Pancreatic Ducts diagnostic imaging
Pancreatic Neoplasms diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 22
- Issue :
- 43
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 27920477
- Full Text :
- https://doi.org/10.3748/wjg.v22.i43.9562