RT Journal
A1 Wiesenauer CA, Schmidt C, Cummings OW, et al
T1 PReoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD June 1
VO 138
IS 6
SP 610
OP 618
DO 10.1001/archsurg.138.6.610
UL http://dx.doi.org/10.1001/archsurg.138.6.610
AB Hypothesis 
    Malignant intraductal papillary mucinous neoplasms (IPMNs) can be predicted before surgery.Design 
    Retrospective review of a prospectively collected database.Setting 
    Academic, urban, tertiary care hospital.Patients 
    Sixty-four consecutive patients with a pathological diagnosis of IPMN.Interventions 
    All 64 patients underwent surgical intervention for IPMN between December 8, 1988, and October 16, 2002.Main Outcome Measures 
    Reliable predictors of malignancy.Results 
    The 64 patients underwent 69 operations: 39 pancreaticoduodenectomies, 18 distal pancreatectomies, 7 total pancreatectomies, 4 neck and/or body pancreatectomies, and 1 cystgastrostomy with pancreatic biopsy. Twenty-three of 69 specimens were malignant—12 in situ (high-grade dysplasia) and 11 invasive. In a univariate analysis of 12 clinical signs or symptoms recorded, diabetes mellitus and jaundice showed a significant association with malignancy of IPMN. Of 24 serum chemistry studies, hematologic studies, and tumor marker analyses (in serum, bile, and pancreatic fluid), elevation of serum alkaline phosphatase and glucose levels showed correlation with malignancy. Computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography findings did not distinguish between benign and malignant tumors. Atypia on preoperative cytologic analysis was specific for malignancy (93%) but lacked the same degree of sensitivity (40% in situ, 91% invasive, and 67% overall).Conclusions 
    Malignancy of IPMNs is suggested by new-onset diabetes mellitus, jaundice, and elevations in serum glucose or alkaline phosphatase levels. Atypia on preoperative cytologic testing is the finding most predictive of malignancy. The absence of these features does not predict benign disease. These findings may help guide patient and physician decision making.