Mural nodules and prevalence of high-grade dysplasia in branch duct intraductal papillary mucinous neoplasm of the pancreas undergoing resection.

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  • Additional Information
    • Source:
      Publisher: Oxford University Press on behalf of BJS Foundation Ltd Country of Publication: England NLM ID: 0372553 Publication Model: Print Cited Medium: Internet ISSN: 1365-2168 (Electronic) Linking ISSN: 00071323 NLM ISO Abbreviation: Br J Surg Subsets: MEDLINE
    • Publication Information:
      Publication: 2021- : [Oxford] : Oxford University Press on behalf of BJS Foundation Ltd.
      Original Publication: [Bristol, England : Baltimore : John Wright & Sons ; Williams & Wilkins Co.
    • Subject Terms:
      Pancreatectomy*/methods ; Pancreatic Neoplasms*/surgery ; Pancreatic Neoplasms*/pathology ; Pancreatic Intraductal Neoplasms*/pathology ; Pancreatic Intraductal Neoplasms*/surgery; Humans ; Male ; Female ; Aged ; Middle Aged ; Carcinoma, Pancreatic Ductal/surgery ; Carcinoma, Pancreatic Ductal/pathology ; Prevalence ; Pancreatic Ducts/pathology ; Pancreatic Ducts/surgery ; Retrospective Studies ; Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/surgery ; Neoplasm Grading
    • Abstract:
      Background: A mural module (MN) within a branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) could be a potential target for local treatment. The main aim was to describe the location of the highest grade of dysplasia relative to the mural module to assess the relevance of local treatment.
      Methods: Observational study of patients who underwent a pancreatic resection for suspected high-risk IPMN because of a mural module within a BD-IPMN (2012-2022). All patients had preoperative imaging confirming the enhancing mural module. The mural module was considered as a theoretical appropriate target for local destruction if no cancer or high-grade dysplasia (HGD) was described elsewhere than in the mural module.
      Results: Eighty-two patients (male: 44 (54%); mean age: 65 ± 9.2 years) were included. The mean size of BD-IPMN containing the mural module was 32 ± 14.8 mm. The mural module mean diameter was 10.5 ± 5.6 mm, and the main pancreatic duct (MPD) mean diameter was 5.2 ± 3.6 mm. Six patients presented invasive carcinoma (7%), 37 had HGD (45%), and 39 (48%) had exclusively low-grade dysplasia. The mural module was dysplastic in 70 cases (85%). The mural module was considered a relevant target for local ablation in 45 patients (55%), whereas 37 patients (45%) had HGD/invasive carcinoma distant from the mural module. HGD was exclusively present in the mural module in 6/82 patients (7%). Factors independently associated with 'relevant indication for local treatment' were female gender (P = 0.004; OR = 5.2, 95% c.i. 1.7 to 15.9) and MPD < 5 mm (P < 0.0001; OR = 8.6, 95% c.i. 2.7 to 26.8).
      Conclusion: In resected pancreata, BD-IPMN mural modules are associated with HGD distant from the mural module almost half of cases. The findings question the safety of local treatment, supporting pancreatectomy as the best approach.
      (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].)
    • Publication Date:
      Date Created: 20241129 Date Completed: 20241129 Latest Revision: 20241218
    • Publication Date:
      20241218
    • Accession Number:
      10.1093/bjs/znae292
    • Accession Number:
      39612583