Intraductal Papillary Mucinous Neoplasms of the Pancreas

Rationale and Objectives

Intraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma.

Materials and Methods

A total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups.

Results

Fifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups ( P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups ( P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients ( P < .05).

Conclusions

IPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes.

Introduction

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) originate from the ductal epithelium with papillary proliferation and dilation of the main pancreatic duct or its major branches . IPMN is recognized as a premalignant lesion, which may progress from an adenoma to a carcinoma . Histologically, IPMNs are divided into four categories: IPMNs with (1) low-grade dysplasia, (2) moderate-grade dysplasia, (3) high-grade dysplasia, and (4) IPMNs associated with invasive carcinomas . Several studies have reported that approximately 4%–10% of individuals with IPMN develop pancreatic ductal adenocarcinoma (PDAC) . There is emerging evidence suggesting that biological behavior and long-term survival differ between patients diagnosed with IPMNs associated with invasive carcinomas and patients diagnosed with PDAC associated with IPMN .

According to the 2012 International Consensus Guidelines for the management of IPMNs and mucinous cystic neoplasm of the pancreas, computed tomography (CT) is recommended to screen the malignant potential of IPMNs and to distinguish IPMNs from other types of lesions . However, data that demonstrate that ability of CT to differentiate between IPMNs associated with invasive carcinomas and PDAC-associated IPMNs are limited. Compared with ultrasound, spiral CT and magnetic resonance imaging (MRI) can provide a clearer image. The diagnostic performance of multidetector CT and MRI for identifying the malignant potential of pancreatic IPMNs was similar . MRI has the advantages of no radiation and multiparameter imaging, but is expensive and takes a long time to scan. Spiral CT, with fewer relative contraindications and scanning speed and other characteristics, usually as the first line inspection, so we choose the spiral CT as a research tool for further research.

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Methods

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Pathologic Diagnosis

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TABLE 1

Patient Demographics and Intraductal Papillary Mucinous Neoplasm (IPMN) Pathologic Characteristics

Total ( n = 31) Age 63.0 ± 7.2 Sex (Male:Female) 2.4:1 Location, n (%) Head 18(58.1) Body 8(25.8) Tail 5(16.1) Radiologic type, n (%) Main duct type 28(90.3) Branch duct type 1(3.2) Mixed type 2(6.5) Degree of invasion, n (%) IPMC-I 15(48.4) IPMN associated with an invasive carcinoma 16(51.6) T stage, n (%) T1, T2 21(67.7) T3, T4 10(32.3) Lymphatic metastasis, n (%) 6(19.4)

IPMC-I, intraductal papillary mucinous carcinoma.

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CT Scanning

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Image Analysis

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Ethical Approval

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Statistical Analysis

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Results

CT Scanning

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TABLE 2

Patient Demographics and CT Characteristics Between IPMC-I and PDAC-PIMN Cases

IPMC-I ( n = 15) PDAC-IPMN ( n = 16)P Age 61.93 ± 7.89 63.94 ± 7.90 .486 Sex (Male:Female) 2.0:1 3.0:1 .454 CEA >5, n (%) 2(13.3) 3(18.8) .532 CA199 >37, n (%) 7(46.7) 10(62.5) .300 Location, n (%) .056 Head 12(80.0) 6(37.5) Body 2(13.3) 6(37.5) Tail 1(6.7) 4(25.0) Radiologic type, n (%) .616 Main duct type 14(93.3) 14(87.4) Branch duct type 1(6.7) 1(6.3) Mixed type 0 1(6.3) Tumor size, (mm) 46.7 ± 21.1 33.6 ± 13.9 .054 Wall size (mm) 12.6 ± 5.9 14.7 ± 7.3 .396 Main pancreatic duct diameter (mm) 10.2 ± 4.7 5.1 ± 3.6.003 Arterial increased CT value (HU) 29.2 ± 12.4 14.2 ± 8.8.001 Venous increased CT value (HU) 44.6 ± 12.0 28.4 ± 12.3.000 T stage, n (%).035 T1, T2 13(86.7) 8(50.0) T3, T4 2(13.3) 8(50.0) Lymphatic metastasis, n (%) 2(13.3) 4(25.0) .359

CA, carbohydrate antigen; CEA, carcino-embryonic antigen; CT, computed tomography; IPMC, intraductal papillary mucinous carcinoma; IPMN, intraductal papillary mucinous neoplasms; PDAC, pancreatic ductal adenocarcinoma.

Results of a Student t test are presented, and significant P values are in bold ( P < .05).

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Discussion

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Conclusions

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