Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas: a seven institution study from the central pancreas consortium

Stephanie Kerlakian, Vikrom K. Dhar, Daniel E. Abbott, David A. Kooby, Nipun B. Merchant, Hong J. Kim, Robert C. Martin, Charles R. Scoggins, David Jason Bentrem, Sharon M. Weber, Shishir K. Maithel, Syed A. Ahmad, Sameer H. Patel*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with “high risk stigmata” (HRS) or “worrisome features” (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC). Methods: Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines. Results: 168 (61%) patients had head/uncinate cysts, while 107 (39%) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55% vs. 40%), had at least one HRS (24% vs. 11%), and more often harbored HGD or IC(49% vs. 27%)[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02). Discussion: Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs.

Original languageEnglish (US)
Pages (from-to)482-488
Number of pages7
JournalHPB
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2019

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Pancreatic Neoplasms
Cysts
Pancreas
Christianity
Neoplasms
Head
Neck
Consensus
Decision Making
Multivariate Analysis
Odds Ratio
Guidelines

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Kerlakian, Stephanie ; Dhar, Vikrom K. ; Abbott, Daniel E. ; Kooby, David A. ; Merchant, Nipun B. ; Kim, Hong J. ; Martin, Robert C. ; Scoggins, Charles R. ; Bentrem, David Jason ; Weber, Sharon M. ; Maithel, Shishir K. ; Ahmad, Syed A. ; Patel, Sameer H. / Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas : a seven institution study from the central pancreas consortium. In: HPB. 2019 ; Vol. 21, No. 4. pp. 482-488.
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title = "Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas: a seven institution study from the central pancreas consortium",
abstract = "Background: Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with “high risk stigmata” (HRS) or “worrisome features” (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC). Methods: Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines. Results: 168 (61{\%}) patients had head/uncinate cysts, while 107 (39{\%}) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55{\%} vs. 40{\%}), had at least one HRS (24{\%} vs. 11{\%}), and more often harbored HGD or IC(49{\%} vs. 27{\%})[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02). Discussion: Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs.",
author = "Stephanie Kerlakian and Dhar, {Vikrom K.} and Abbott, {Daniel E.} and Kooby, {David A.} and Merchant, {Nipun B.} and Kim, {Hong J.} and Martin, {Robert C.} and Scoggins, {Charles R.} and Bentrem, {David Jason} and Weber, {Sharon M.} and Maithel, {Shishir K.} and Ahmad, {Syed A.} and Patel, {Sameer H.}",
year = "2019",
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doi = "10.1016/j.hpb.2018.09.018",
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Kerlakian, S, Dhar, VK, Abbott, DE, Kooby, DA, Merchant, NB, Kim, HJ, Martin, RC, Scoggins, CR, Bentrem, DJ, Weber, SM, Maithel, SK, Ahmad, SA & Patel, SH 2019, 'Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas: a seven institution study from the central pancreas consortium', HPB, vol. 21, no. 4, pp. 482-488. https://doi.org/10.1016/j.hpb.2018.09.018

Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas : a seven institution study from the central pancreas consortium. / Kerlakian, Stephanie; Dhar, Vikrom K.; Abbott, Daniel E.; Kooby, David A.; Merchant, Nipun B.; Kim, Hong J.; Martin, Robert C.; Scoggins, Charles R.; Bentrem, David Jason; Weber, Sharon M.; Maithel, Shishir K.; Ahmad, Syed A.; Patel, Sameer H.

In: HPB, Vol. 21, No. 4, 01.04.2019, p. 482-488.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas

T2 - a seven institution study from the central pancreas consortium

AU - Kerlakian, Stephanie

AU - Dhar, Vikrom K.

AU - Abbott, Daniel E.

AU - Kooby, David A.

AU - Merchant, Nipun B.

AU - Kim, Hong J.

AU - Martin, Robert C.

AU - Scoggins, Charles R.

AU - Bentrem, David Jason

AU - Weber, Sharon M.

AU - Maithel, Shishir K.

AU - Ahmad, Syed A.

AU - Patel, Sameer H.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with “high risk stigmata” (HRS) or “worrisome features” (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC). Methods: Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines. Results: 168 (61%) patients had head/uncinate cysts, while 107 (39%) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55% vs. 40%), had at least one HRS (24% vs. 11%), and more often harbored HGD or IC(49% vs. 27%)[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02). Discussion: Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs.

AB - Background: Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with “high risk stigmata” (HRS) or “worrisome features” (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC). Methods: Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines. Results: 168 (61%) patients had head/uncinate cysts, while 107 (39%) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55% vs. 40%), had at least one HRS (24% vs. 11%), and more often harbored HGD or IC(49% vs. 27%)[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02). Discussion: Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs.

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