It may be possible to predict malignant intraductal papillary mucinous neoplasms (IPMNs) before surgery.
Researchers from the United States performed a retrospective review of a prospectively collected database.
They included 64 consecutive patients with a pathological diagnosis of IPMN, all underwent surgical intervention for IPMN between 1988 and 2002.
The team aimed to identify reliable predictors of malignancy.
|23 of 69 specimens were malignant.|
|Archives of Surgery|
The patients underwent 69 operations, including 39 pancreaticoduodenectomies, 18 distal pancreatectomies, 7 total pancreatectomies, 4 neck and/or body pancreatectomies, and 1 cystgastrostomy with pancreatic biopsy.
The research team found that 23 of 69 specimens were malignant.
They found that univariate analysis identified diabetes mellitus and jaundice as having a significant association with malignancy of IPMN.
In addition, serum chemistry, hematologic studies, and tumor marker analyses, elevation of serum alkaline phosphatase and glucose levels also correlated with malignancy.
Computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography findings were unable to distinguish between benign and malignant tumors.
The team found that atypia on preoperative cytologic analysis was specific for malignancy (93%). However, this varied in sensitivity.
Dr Chad Wiesenauer's team concluded, "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".