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Main pancreatic duct dilation greater than 6 mm is associated with an increased risk of high-grade dysplasia and cancer in IPMN patients

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Abstract

Introduction

IPMNs, considered precursor lesions of pancreatic adenocarcinoma (PDAC), might display histological alteration varying from low-grade dysplasia (LGD) to cancer. Nevertheless, the prevalence of PDAC is far below the prevalence of IPMN; therefore, not all of these precursor lesions finally progress to cancer. Preoperative features consistent with and finding at final histology of high-grade dysplasia (HGD) or cancer are currently lacking. The aim of this study is to correlate the presence of preoperative clinical features with the finding of advance lesions at final histology.

Methods

This is retrospective cohort analysis of patients who underwent surgery for histologically confirmed IPMNs at Karolinska University Hospital, from 2008 to 2015.

Results

MPD 6–9.9 mm and ≥ 10 mm were associated with an increased risk of HGD/cancer (respectively, OR 2.92, CI 1.38–6.20, p = 0.005 and OR 2.65, CI 1.12–6.25, p = 0.02). Preoperative high CA19.9 and jaundice were both associated with a higher risk of HGD/cancer at final histology (respectively, OR 4.15, CI 1.90–9.05, p = 0.0003 and OR 15.36, CI 1.94–121.22, p = 0.009). At sex- and age-adjusted multivariable logistic regression analysis, MPD between 6 and 9.9 mm (OR 2.64, CI 1.15–6.06, p = 0.02), jaundice (OR 12.43, CI 1.44–106.93, p = 0.02), and elevated CA19.9 (OR 3.71, CI 1.63–8.46, p = 0.001) remained associated with the occurrence of HGD/cancer.

Discussion

The presence of MPD dilation ≥ 6 mm, jaundice, and elevated CA19.9 in IPMN patients are consistent with the finding for HGD/cancer at final histology, thus representing possible markers of advanced lesions suitable for earlier or preventive curative surgical treatment.

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Funding

The present study was supported by Cancerfonden, Sweden (CAN 2014/634 and CAN 2014/621) and ALF Medicine (2016 #20150113).

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Author notes

  1. Zeeshan Ateeb and Roberto Valente contributed equally to this work.

Authors and Affiliations

  1. Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden

    Zeeshan Ateeb, Roberto Valente, Linnéa Malgerud, Yasmine Schlieper, Elena Rangelova, Johannes Matthias Löhr, Urban Arnelo & Marco Del Chiaro

  2. Digestive and Liver Diseases Unit, Sapienza University of Rome, Rome, Italy

    Roberto Valente

  3. Division of Radiology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden

    Raffaella M. Pozzi-Mucelli

  4. Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    Carlos Fernandez-Moro

  5. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, C-313, Aurora, CO, 80045, USA

    Marco Del Chiaro

Authors
  1. Zeeshan Ateeb
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  2. Roberto Valente
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  3. Raffaella M. Pozzi-Mucelli
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  6. Elena Rangelova
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  9. Urban Arnelo
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  10. Marco Del Chiaro
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Contributions

Zeeshan Ateeb collected the data and contributed to write the manuscript. Roberto Valente contributed to write the manuscript and performed the statistical analysis. Yasmine Schlieper contributed to collect data. Carlos Fernaned Moro revised the patient’s histology. Raffaella M. Pozzi-Mucelli revised the patient’s radiological files. Linnea Malgerud, Elena Rangelova, Johannes Matthias Löhr, and Urban Arnelo critically revised the manuscript. Marco Del Chiaro was responsible of the study design and contributed to write the paper.

Corresponding author

Correspondence to Marco Del Chiaro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained by the local ethical committee (EPN 2015/1544–31/4).

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Study highlights

What is current knowledge:

Pancreatic IPMNs are considered the precursor lesions of pancreas cancer but not all of them progress to cancer.

Preoperative clinical/radiological characteristics consistent with advanced lesions at final histology are currently lacking.

What is new here:

MPD ≥ 6mm, jaundice, and high CA19-9 are consistent with an increased risk of advanced histology in IPMN patients.

Those criteria might improve diagnostic accuracy and therefore increase the chances to achieve a curative treatment.

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Ateeb, Z., Valente, R., Pozzi-Mucelli, R.M. et al. Main pancreatic duct dilation greater than 6 mm is associated with an increased risk of high-grade dysplasia and cancer in IPMN patients. Langenbecks Arch Surg 404, 31–37 (2019). https://doi.org/10.1007/s00423-018-1740-8

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  • DOI: https://doi.org/10.1007/s00423-018-1740-8

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