Long-term outcomes of patients with multifocal intraductal papillary mucinous neoplasm following pancreatectomy

Important radiological and clinicopathological risk factors for the recurrence of intraductal papillary mucinous neoplasms after surgical resection

OBJECTIVES

To assess significant radiological and clinicopathological risk factors for post-surgery recurrence in patients with intraductal papillary mucinous neoplasm (IPMN).

MATERIALS AND METHODS

Patients with IPMNs who underwent surgery from 2011 to 2021 at a single center were retrospectively included. Two reviewers evaluated CT findings according to international guidelines. Clinicopathological data were collected from medical records and surgical pathology reports. Patients were monitored for recurrence with contrast-enhanced CT or MRI up to 2023. Univariable Cox regression analysis included potential risk factors: all high-risk stigmata and worrisome features in the international guidelines, age, sex, tumor location, type, carcinoembryonic antigen, surgery type, postsurgical residual cyst, adjuvant treatment, pathologic grade, type, size, margin status, lymph node metastasis, gland type, and pancreatic intraepithelial neoplasia. Variables with p < 0.2 were included in multivariate analysis.

RESULTS

Among 332 patients (mean age, 66.3 ± 9.0 years; 212 men), recurrence occurred in 39 (11.7%) over a median follow-up of 3.2 years (range: 0.1-12.3 years). Two- and five-year recurrence-free survival rates were 91.2% and 86.4%, respectively. Significant radiological risk factors included enhancing mural nodule (EMN) presence (hazard ratio [HR] 5.088, p = 0.007) and lymphadenopathy (HR 2.837, p = 0.01). Associated invasive carcinoma (HR 25.030), lymph node metastasis (HR 27.562), adjuvant treatment (HR 0.203), and history of pancreatitis (HR 2.608) were also significant. Most imaging features showed moderate to excellent interobserver agreement, except for thickened/enhancing cyst walls (κ, 0.25).

CONCLUSION

The presence of EMNs and lymphadenopathy, along with several clinicopathologic factors, were significantly associated with IPMN recurrence.

KEY POINTS

Question Understanding postoperative recurrence risk in IPMN patients is crucial for determining surveillance strategies; however, research on radiologic risk factors remains limited. Findings The presence of EMNs and lymphadenopathy were identified as significant radiologic risk factors for the postoperative recurrence of IPMN, along with clinicopathologic factors. Clinical relevance IPMN recurrence is significantly associated with imaging findings like EMNs and lymphadenopathy, as well as clinical and pathologic factors. It can guide the development of tailored postoperative surveillance strategies for IPMN patients in further studies.

Retrospective analysis of pathological types and imaging features in pancreatic cancer: A comprehensive study

BACKGROUND

Pancreatic cancer remains one of the most lethal malignancies worldwide, with a poor prognosis often attributed to late diagnosis. Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.

AIM

To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.

METHODS

We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution. Pathological types were determined by histopathological examination of the surgical specimens or biopsy samples. The imaging features were assessed using computed tomography, magnetic resonance imaging, and endoscopic ultrasound. Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.

RESULTS

There were 320 (64%) cases of pancreatic ductal adenocarcinoma, 75 (15%) of intraductal papillary mucinous neoplasms, 50 (10%) of neuroendocrine tumors, and 55 (11%) of other rare types. Distinct imaging features were identified in each pathological type. Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography, whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules. Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging. Statistical analysis revealed significant correlations between specific imaging features and pathological types (P < 0.001).

CONCLUSION

This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features. These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.

International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas

This study group aimed to revise the 2017 international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, and mainly focused on five topics; the revision of high-risk stigmata (HRS) and worrisome features (WF), surveillance of non-resected IPMN, surveillance after resection of IPMN, revision of pathological aspects, and investigation of molecular markers in cyst fluid. A new development from the prior guidelines is that systematic reviews were performed for each one of these topics, and published separately to provide evidence-based recommendations. One of the highlights of these new "evidence-based guidelines" is to propose a new management algorithm, and one major revision is to include into the assessment of HRS and WF the imaging findings from endoscopic ultrasound (EUS) and the results of cytological analysis from EUS-guided fine needle aspiration technique, when this is performed. Another key element of the current guidelines is to clarify whether lifetime surveillance for small IPMNs is required, and recommends two options, "stop surveillance" or "continue surveillance for possible development of concomitant pancreatic ductal adenocarcinoma", for small unchanged BD-IPMN after 5 years surveillance. Several other points are also discussed, including identifying high-risk features for recurrence in patients who underwent resection of non-invasive IPMN with negative surgical margin, summaries of the recent observations in the pathology of IPMN. In addition, the emerging role of cyst fluid markers that can aid in distinguishing IPMN from other pancreatic cysts and identify those IPMNs that harbor high-grade dysplasia or invasive carcinoma is discussed.