Evaluation of intraductal papillary mucinous neoplasms detected incidentally with magnetic resonance cholangiopancreatography

Year 2023, Volume: 9 Issue: 5 - September 2023, 903 - 909, 04.09.2023

Mustafa Orhan Nalbant

https://doi.org/10.18621/eurj.1282203

Abstract

Objectives: The aim of this study was to estimate the prevalence of coincidentally found intraductal papillary mucinous neoplasms (IPMNs) and assess their features with magnetic resonance cholangiopancreatography (MRCP) imaging.

Methods: The prevalence of incidentally detected IPMN was evaluated in 951 patients who underwent MRCP examination for various indications. MRCP images were assessed to analyze the number, size, location, and internal structure of lesions in patients with IPMN. Furthermore, the association between IPMN prevalence and age and gender was evaluated.

Results: IPMN was detected in 102 (10.7%) of 951 patients. Solitary IPMNs were located in different parts of the pancreas: in the uncinate process in 8 (7.8%), in the head and neck in 19 (18.6%), in the corpus in 10 (9.8%), and in the tail in 7 (6.9%) patients. IPMN was multiple in 58 (56.9%) patients. IPMN was identified in 41 (6.18%) patients under 65 years and 61 (21.18%) patients over 65 years, and the variance was statistically substantial (p < 0.001). IPMN diameter was 7.22 ± 4.3 mm in patients under 65 years and 9.21 ± 4.74 mm in those over 65 years, which was statistically significant (p = 0.048). Patients who were older were more likely to have multiple IPMNs (p = 0.010).

Conclusions: IPMNs increase in frequency, quantity, and size with age. MRCP is the most essential sequence for determining main pancreatic duct (MPD) involvement or communication, a critical finding for diagnosis. Since MRCP is capable of screening patients at very short intervals, it may be utilized for follow-up imaging in IPMN patients.

Keywords

Intraductal papillary mucinous neoplasm, pancreatic duct, pancreatic cystic lesion, magnetic resonance cholangiopancreatography

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors

References

• 1. Shyr YM, Su CH, Tsay SH, Lui WY. Mucin-producing neoplasms of the pancreas. Intraductal papillary and mucinous cystic neoplasms. Ann Surg 1996;223:141-6.
• 2. Jabłońska B. Biliary cysts: etiology, diagnosis and management. World J Gastroenterol 2012;18:4801-10.
• 3. Megibow AJ, Lombardo FP, Guarise A, Carbognin G, Scholes J, Rofsky NM, et al. Cystic pancreatic masses: cross-sectional imaging observations and serial follow-up. Abdom Imaging 2001;26:640-7.
• 4. Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg 2003;7:890-7.
• 5. Fernández-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003;138:427-3.
• 6. Balcom IV JH, Fernandez-Del Castillo C, Warshaw AL. Cystic lesions in the pancreas: when to watch, when to resect. Curr Gastroenterol Rep 2000;2:152-8.
• 7. Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L. Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 2002;223:547-53.
• 8. Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802-7.
• 9. Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL. Cystic neoplasms of the pancreas. N Engl J Med 2004;351:1218-26.
• 10. Tada M, Kawabe T, Arizumi M, Togawa O, Matsubara S, Yamamoto N, et al. Pancreatic cancer in patients with pancreatic cystic lesions: a prospective study in 197 patients. Clin Gastroenterol Hepatol 2006;4:1265-70.
• 11. Kawakubo K, Tada M, Isayama H, Sasahira N, Nakai Y, Yamamoto K, et al. Incidence of extrapancreatic malignancies in patients with intraductal papillary mucinous neoplasms of the pancreas. Gut 2011;60:1249-53.
• 12. Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, et al. Pancreatic cancer. Nat Rev Dis Primers 2016;2:16022.
• 13. Vege SS, Ziring B, Jain R, Moayyedi P; Clinical Guidelines Committee; American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:819-22.
• 14. Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738-53.
• 15. Pergolini I, Sahora K, Ferrone CR, Morales-Oyarvide V, Wolpin BM, Mucci LA, et al. Long-term risk of pancreatic malignancy in patients with branch duct intraductal papillary mucinous neoplasm in a referral center. Gastroenterology 2017;153:1284-94.
• 16. Petrone MC, Magnoni P, Pergolini I, Capurso G, Traini M, Doglioni C, et al. Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature? Clin Transl Gastroenterol 2018;9:e158.
• 17. Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:824-48.
• 18. Yamaguchi K, Kanemitsu S, Hatori T, Maguchi H, Shimizu Y, Tada M, et al. Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas 2011;40:571-80.
• 19. Patra KC, Bardeesy N, Mizukami Y. Diversity of precursor lesions for pancreatic cancer: the genetics and biology of intraductal papillary mucinous neoplasm. Clin Transl Gastroenterol 2017;8:e86.
• 20. de Jong K, Bruno MJ, Fockens P. Epidemiology, diagnosis, and management of cystic lesions of the pancreas. Gastroenterol Res Pract 2012;2012:147465.
• 21. Machado NO, Al Qadhi H, Al Wahibi K. Intraductal papillary mucinous neoplasm of pancreas. N Am J Med Sci 2015;7:160-75.
• 22. Tanaka M. Clinical management and surgical decision-making of IPMN of the pancreas. Methods Mol Biol 2019;1882:9-22.
• 23. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al.; International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183-97.
• 24. Kim JH, Hong SS, Kim YJ, Kim JK, Eun HW. Intraductal papillary mucinous neoplasm of the pancreas: differentiate from chronic pancreatits by MR imaging. Eur J Radiol 2012;81:671-6.
• 25. Procacci C, Carbognin G, Biasiutti C, Guarise A, Ghirardi C, Schenal G. Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation. Eur Radiol 2001;11:1939-51.
• 26. Lim JH, Lee G, Oh YL. Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 2001;21:323-37.
• 27. Procacci C, Megibow AJ, Carbognin G, Guarise A, Spoto E, Biasiutti C, et al. Intraductal papillary mucinous tumor of the pancreas: a pictorial essay. Radiographics 1999;19:1447-63.
• 28. Pilleul F, Rochette A, Partensky C, Scoazec JY, Bernard P, Valette PJ. Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 2005;21:237-44.
• 29. Italian Association of Hospital Gastroenterologists and Endoscopists; Italian Association for the Study of the Pancreas; Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, et al.; Cystic Pancreatic Neoplasm Study Group. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014;46:479-93.
• 30. Tamura K, Ohtsuka T, Ideno N, Aso T, Kono H, Nagayoshi Y, et al. Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report. JOP 2013;14:450-3.
• 31. He J, Cameron JL, Ahuja N, Makary MA, Hirose K, Choti MA, et al. Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 2013;216:657-65.
• 32. Torisu Y, Takakura K, Kinoshita Y, Tomita Y, Nakano M, Saruta M. Pancreatic cancer screening in patients with presumed branch-duct intraductal papillary mucinous neoplasms. World J Clin Oncol 2019;10:67-74.
• 33. Ideno N, Ohtsuka T, Matsunaga T, Kimura H, Watanabe Y, Tamura K, et al. Clinical significance of GNAS mutation in intraductal papillary mucinous neoplasm of the pancreas with concomitant pancreatic ductal adenocarcinoma. Pancreas 2015;44:311-20.
• 34. Ideno N, Ohtsuka T, Kono H, Fujiwara K, Oda Y, Aishima S, et al. Intraductal papillary mucinous neoplasms of the pancreas with distinct pancreatic ductal adenocarcinomas are frequently of gastric subtype. Ann Surg 2013;258:141-51.
• 35. Mandai K, Uno K, Yasuda K. Does a family history of pancreatic ductal adenocarcinoma and cyst size influence the follow-up strategy for intraductal papillary mucinous neoplasms of the pancreas? Pancreas 2014;43:917-21.
• 36. Moris M, Bridges MD, Pooley RA, Raimondo M, Woodward TA, Stauffer JA, et al. Association between advances in high-resolution cross-section imaging technologies and increase in prevalence of pancreatic cysts from 2005 to 2014. Clin Gastroenterol Hepatol 2016;14:585-93.