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Elliot K Fishman - One of the best experts on this subject based on the ideXlab platform.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Ross Beckman, Lindsey Manos, John L Cameron, Matthew J Weiss, Elliot K FishmanAbstract:Abstract Background The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) Results BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03–1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40–53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. Conclusion The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3–5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a “worrisome feature” in a future guidelines update.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Lindsey Manos, John L Cameron, Matthew J Weiss, Ross M Beckman, Elliot K FishmanAbstract:BACKGROUND The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). METHODS 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) <5 mm, cyst size <3 cm, no mural nodules, negative cyst fluid cytology for adenoCarcinoma, or serum carbohydrate antigen 19-9 (CA 19-9) <37 U/L. RESULTS BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03-1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40-53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. CONCLUSION The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3-5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a "worrisome feature" in a future guidelines update.
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mdct of intraductal papillary mucinous neoplasm of the pancreas evaluation of features predictive of Invasive Carcinoma
American Journal of Roentgenology, 2006Co-Authors: Satomi Kawamoto, Ralph H Hruban, Leo P Lawler, Karen M Horton, Elliot K FishmanAbstract:OBJECTIVE. The purpose of our study was to evaluate factors predictive of the presence of Invasive Carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT.MATERIALS AND METHODS. Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a pathologic diagnosis of IPMN were retrospectively assessed. CT was performed with a 4-MDCT scanner with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Arterial and venous phase images were acquired at 25 and 50-60 sec from the start of IV contrast administration. Type of ductal involvement, location, tumor size in branch duct type and combined type lesions, caliber of the main pancreatic duct, caliber of the common bile duct or common hepatic duct, and solid appearance of the lesion were assessed on CT and correlated with pathologic findings for Invasive Carcinoma.RESULTS. Pathologic analysis revealed Carcinoma in situ in seven patients (19%)...
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intraductal papillary mucinous neoplasm of the pancreas can benign lesions be differentiated from malignant lesions with multidetector ct
Radiographics, 2005Co-Authors: Satomi Kawamoto, Ralph H Hruban, Leo P Lawler, Karen M Horton, Elliot K FishmanAbstract:Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a distinct clinicopathologic entity that is being recognized with increasing frequency. In 25%–44% of IPMNs treated with surgical resection, associated Invasive Carcinoma has been reported. Surgical resection is the treatment of choice for most IPMNs. Preoperative determination of the presence or absence of associated Invasive Carcinoma is crucial. The prognosis is worse if there is associated Invasive Carcinoma; when Invasive Carcinoma is present, the surgical procedure may be modified to include resection of regional lymph nodes. The spectrum of appearances of IPMN, which includes adenoma, borderline lesion, and lesions with associated Carcinoma in situ or Invasive Carcinoma, was studied with 16-section multidetector computed tomography (CT) and histologic correlation. CT was performed with dual-phase acquisition; the reconstructed images were reviewed on a workstation with axial scrolling and interactive multiplanar reformation and three...
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intraductal papillary mucinous neoplasm of the pancreas can benign lesions be differentiated from malignant lesions with multidetector ct
Radiographics, 2005Co-Authors: Satomi Kawamoto, Ralph H Hruban, Leo P Lawler, Karen M Horton, Elliot K FishmanAbstract:Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a distinct clinicopathologic entity that is being recognized with increasing frequency. In 25%-44% of IPMNs treated with surgical resection, associated Invasive Carcinoma has been reported. Surgical resection is the treatment of choice for most IPMNs. Preoperative determination of the presence or absence of associated Invasive Carcinoma is crucial. The prognosis is worse if there is associated Invasive Carcinoma; when Invasive Carcinoma is present, the surgical procedure may be modified to include resection of regional lymph nodes. The spectrum of appearances of IPMN, which includes adenoma, borderline lesion, and lesions with associated Carcinoma in situ or Invasive Carcinoma, was studied with 16-section multidetector computed tomography (CT) and histologic correlation. CT was performed with dual-phase acquisition; the reconstructed images were reviewed on a workstation with axial scrolling and interactive multiplanar reformation and three-dimensional reformation techniques. Features predictive of Invasive Carcinoma in IPMN at CT and other imaging studies include involvement of the main pancreatic duct, marked dilatation of the main pancreatic duct, diffuse or multifocal involvement, the presence of a large mural nodule or solid mass, large size of the mass, and obstruction of the common bile duct.
Ralph H Hruban - One of the best experts on this subject based on the ideXlab platform.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Ross Beckman, Lindsey Manos, John L Cameron, Matthew J Weiss, Elliot K FishmanAbstract:Abstract Background The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) Results BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03–1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40–53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. Conclusion The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3–5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a “worrisome feature” in a future guidelines update.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Lindsey Manos, John L Cameron, Matthew J Weiss, Ross M Beckman, Elliot K FishmanAbstract:BACKGROUND The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). METHODS 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) <5 mm, cyst size <3 cm, no mural nodules, negative cyst fluid cytology for adenoCarcinoma, or serum carbohydrate antigen 19-9 (CA 19-9) <37 U/L. RESULTS BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03-1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40-53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. CONCLUSION The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3-5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a "worrisome feature" in a future guidelines update.
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a revised classification system and recommendations from the baltimore consensus meeting for neoplastic precursor lesions in the pancreas
The American Journal of Surgical Pathology, 2015Co-Authors: Olca Basturk, Volkan N Adsay, M Goggins, Noriyoshi Fukushima, Seungmo Hong, Laura D Wood, Jorge Alboressaavedra, Andrew V Biankin, Lodewijk A A Brosens, Ralph H HrubanAbstract:International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to Invasive Carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: (1) To improve concordance and to align with practical consequences, a 2-tiered system (low vs. high grade) is proposed for all precursor lesions, with the provision that the current PanIN-2 and neoplasms with intermediate-grade dysplasia now be categorized as low grade. Thus, "high-grade dysplasia" is to be reserved for only the uppermost end of the spectrum ("Carcinoma in situ"-type lesions). (2) Current data indicate that PanIN of any grade at a margin of a resected pancreas with Invasive Carcinoma does not have prognostic implications; the clinical significance of dysplasia at a margin in a resected pancreas with IPMN lacking Invasive Carcinoma remains to be determined. (3) Intraductal lesions 0.5 to 1 cm can be either large PanINs or small IPMNs. The term "incipient IPMN" should be reserved for lesions in this size with intestinal or oncocytic papillae or GNAS mutations. (4) Measurement of the distance between an IPMN and Invasive Carcinoma and sampling of intervening tissue are recommended to assess concomitant versus associated status. Conceptually, concomitant Invasive Carcinoma (in contrast with the "associated" group) ought to be genetically distinct from an IPMN elsewhere in the gland. (5) "Intraductal spread of Invasive Carcinoma" (aka, "colonization") is recommended to describe lesions of Invasive Carcinoma invading back into and extending along the ductal system, which may morphologically mimic high-grade PanIN or even IPMN. (6) "Simple mucinous cyst" is recommended to describe cysts >1 cm having gastric-type flat mucinous lining at most minimal atypia without ovarian-type stroma to distinguish them from IPMN. (7) Human lesions resembling the acinar to ductal metaplasia and atypical flat lesions of genetically engineered mouse models exist and may reflect an alternate pathway of carcinogenesis; however, their biological significance requires further study. These revised recommendations are expected to improve our management and understanding of precursor lesions in the pancreas.
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adjuvant chemoradiotherapy after pancreatic resection for Invasive Carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas
International Journal of Radiation Oncology Biology Physics, 2010Co-Authors: Michael J Swartz, Ralph H Hruban, John L Cameron, Timothy M Pawlik, Jordan M Winter, Mehmet L Guler, Richard D Schulick, Daniel Laheru, Christopher L Wolfgang, Joseph M HermanAbstract:Purpose Intraductal papillary mucinous neoplasms are mucin-producing cystic neoplasms of the pancreas. One-third are associated with Invasive Carcinoma. We examined the benefit of adjuvant chemoradiotherapy (CRT) for this cohort. Methods and Materials Patients who had undergone pancreatic resection at Johns Hopkins Hospital between 1999 and 2004 were reviewed. Of these patients, 83 with a resected pancreatic mass were found to have an intraductal papillary mucinous neoplasm with Invasive Carcinoma, 70 of whom met inclusion criteria for the present analysis. Results The median age at surgery was 68 years. The median tumor size was 3.3 cm, and Invasive Carcinoma was present at the margin in 16% of the patients. Of the 70 patients, 50% had metastases to the lymph nodes and 64% had Stage II disease. The median survival was 28.0 months, and 2- and 5-year survival rate was 57% and 45%, respectively. Of the 70 patients, 40 had undergone adjuvant CRT. Those receiving CRT were more likely to have lymph node metastases, perineural invasion, and Stage II-III disease. The 2-year survival rate after surgery with vs. without CRT was 55.8% vs. 59.3%, respectively ( p = NS). Patients with lymph node metastases or positive surgical margins benefited significantly from CRT ( p = .047 and p = .042, respectively). On multivariate analysis, adjuvant CRT was associated with improved survival, with a relative risk of 0.43 (95% confidence interval, 0.19–0.95; p = .044) after adjusting for major confounders. Conclusion Adjuvant CRT conferred a 57% decrease in the relative risk of mortality after pancreaticoduodenectomy for intraductal papillary mucinous neoplasms with an associated Invasive component after adjusting for major confounders. Patients with lymph node metastases or positive margins appeared to particularly benefit from CRT after definitive surgery.
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mdct of intraductal papillary mucinous neoplasm of the pancreas evaluation of features predictive of Invasive Carcinoma
American Journal of Roentgenology, 2006Co-Authors: Satomi Kawamoto, Ralph H Hruban, Leo P Lawler, Karen M Horton, Elliot K FishmanAbstract:OBJECTIVE. The purpose of our study was to evaluate factors predictive of the presence of Invasive Carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT.MATERIALS AND METHODS. Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a pathologic diagnosis of IPMN were retrospectively assessed. CT was performed with a 4-MDCT scanner with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Arterial and venous phase images were acquired at 25 and 50-60 sec from the start of IV contrast administration. Type of ductal involvement, location, tumor size in branch duct type and combined type lesions, caliber of the main pancreatic duct, caliber of the common bile duct or common hepatic duct, and solid appearance of the lesion were assessed on CT and correlated with pathologic findings for Invasive Carcinoma.RESULTS. Pathologic analysis revealed Carcinoma in situ in seven patients (19%)...
Hiroki Nakayama - One of the best experts on this subject based on the ideXlab platform.
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definitive radiation therapy for Invasive Carcinoma of the vagina impact of high dose rate intracavitary brachytherapy
International Journal of Clinical Oncology, 2013Co-Authors: Tetsuo Nonaka, Yuko Nakayama, Nobutaka Mizoguchi, Ryo Onose, Hisamori Kato, Hiroki NakayamaAbstract:This study was designed to evaluate the efficacy of definitive radiation therapy (RT) for Invasive Carcinoma of the vagina. Twenty-six patients with Invasive Carcinoma of the vagina who received RT were studied retrospectively. The median age was 68 years. The pathologic subtype of vaginal Carcinoma was squamous cell Carcinoma in 24 patients, adenosquamous cell Carcinoma in one patient, and adenoCarcinoma in one patient. The distribution of clinical stage according to the International Federation of Gynecology and Obstetrics staging system was as follows: stage I, seven patients; stage II, 10 patients, stage III, seven patients; and stage IVA, two patients. Twenty patients received external beam radiation therapy (EBRT) combined with high-dose rate intracavitary brachytherapy (HDR-ICBT), and three received EBRT alone. The remaining three patients with stage I disease were given HDR-ICBT alone. The median dose was 50 Gy for EBRT, and 23 Gy for HDR-ICBT. Systemic chemotherapy was administered concurrently with RT to three patients. The median follow-up was 90 months. The initial rate of response to RT was 100%, and complete remission was attained in 21 patients (81%). The 5-year overall survival rate (OS) and the median survival time of the 26 patients were 57% and 97 months, respectively. The 5-year OS for the three patients who received HDR-ICBT alone was 100%. Severe toxicity occurred in three patients—grade 3 rectal hemorrhage in one, grade 3 cystitis in one, and grade 4 cystitis in one. Our results demonstrated that definitive RT with HDR-ICBT is effective for Invasive Carcinoma of the vagina, with acceptable toxicity.
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definitive radiation therapy for Invasive Carcinoma of the vagina impact of high dose rate intracavitary brachytherapy
International Journal of Clinical Oncology, 2013Co-Authors: Tetsuo Nonaka, Yuko Nakayama, Nobutaka Mizoguchi, Ryo Onose, Hisamori Kato, Hiroki NakayamaAbstract:Background This study was designed to evaluate the efficacy of definitive radiation therapy (RT) for Invasive Carcinoma of the vagina.
John L Cameron - One of the best experts on this subject based on the ideXlab platform.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Ross Beckman, Lindsey Manos, John L Cameron, Matthew J Weiss, Elliot K FishmanAbstract:Abstract Background The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) Results BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03–1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40–53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. Conclusion The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3–5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a “worrisome feature” in a future guidelines update.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Lindsey Manos, John L Cameron, Matthew J Weiss, Ross M Beckman, Elliot K FishmanAbstract:BACKGROUND The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). METHODS 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) <5 mm, cyst size <3 cm, no mural nodules, negative cyst fluid cytology for adenoCarcinoma, or serum carbohydrate antigen 19-9 (CA 19-9) <37 U/L. RESULTS BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03-1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40-53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. CONCLUSION The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3-5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a "worrisome feature" in a future guidelines update.
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adjuvant chemoradiotherapy after pancreatic resection for Invasive Carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas
International Journal of Radiation Oncology Biology Physics, 2010Co-Authors: Michael J Swartz, Ralph H Hruban, John L Cameron, Timothy M Pawlik, Jordan M Winter, Mehmet L Guler, Richard D Schulick, Daniel Laheru, Christopher L Wolfgang, Joseph M HermanAbstract:Purpose Intraductal papillary mucinous neoplasms are mucin-producing cystic neoplasms of the pancreas. One-third are associated with Invasive Carcinoma. We examined the benefit of adjuvant chemoradiotherapy (CRT) for this cohort. Methods and Materials Patients who had undergone pancreatic resection at Johns Hopkins Hospital between 1999 and 2004 were reviewed. Of these patients, 83 with a resected pancreatic mass were found to have an intraductal papillary mucinous neoplasm with Invasive Carcinoma, 70 of whom met inclusion criteria for the present analysis. Results The median age at surgery was 68 years. The median tumor size was 3.3 cm, and Invasive Carcinoma was present at the margin in 16% of the patients. Of the 70 patients, 50% had metastases to the lymph nodes and 64% had Stage II disease. The median survival was 28.0 months, and 2- and 5-year survival rate was 57% and 45%, respectively. Of the 70 patients, 40 had undergone adjuvant CRT. Those receiving CRT were more likely to have lymph node metastases, perineural invasion, and Stage II-III disease. The 2-year survival rate after surgery with vs. without CRT was 55.8% vs. 59.3%, respectively ( p = NS). Patients with lymph node metastases or positive surgical margins benefited significantly from CRT ( p = .047 and p = .042, respectively). On multivariate analysis, adjuvant CRT was associated with improved survival, with a relative risk of 0.43 (95% confidence interval, 0.19–0.95; p = .044) after adjusting for major confounders. Conclusion Adjuvant CRT conferred a 57% decrease in the relative risk of mortality after pancreaticoduodenectomy for intraductal papillary mucinous neoplasms with an associated Invasive component after adjusting for major confounders. Patients with lymph node metastases or positive margins appeared to particularly benefit from CRT after definitive surgery.
Neda Amini - One of the best experts on this subject based on the ideXlab platform.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Ross Beckman, Lindsey Manos, John L Cameron, Matthew J Weiss, Elliot K FishmanAbstract:Abstract Background The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) Results BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03–1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40–53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. Conclusion The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3–5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a “worrisome feature” in a future guidelines update.
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minimal main pancreatic duct dilatation in small branch duct intraductal papillary mucinous neoplasms associated with high grade dysplasia or Invasive Carcinoma
Hpb, 2020Co-Authors: Neda Amini, Ralph H Hruban, Neda Rezaee, Joseph R Habib, Alex B Blair, Lindsey Manos, John L Cameron, Matthew J Weiss, Ross M Beckman, Elliot K FishmanAbstract:BACKGROUND The aim of this study was to determine the incidence of high-grade dysplasia (HGD) or Invasive Carcinoma in patients with small branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). METHODS 923 patients who underwent surgical resection for an IPMN were identified. Sendai-negative patients were identified as those without history of pancreatitis or jaundice, main pancreatic duct size (MPD) <5 mm, cyst size <3 cm, no mural nodules, negative cyst fluid cytology for adenoCarcinoma, or serum carbohydrate antigen 19-9 (CA 19-9) <37 U/L. RESULTS BD-IPMN was identified in 388 (46.4%) patients and 89 (22.9%) were categorized as Sendai-negative. Overall, 68 (17.5%) of BD-IPMN had HGD and 62 (16.0%) had an associated Invasive-Carcinoma. Among the 89 Sendai-negative patients, 12 (13.5%) had IPMNs with HGD and only one patient (1.1%) had Invasive-Carcinoma. Of note, older age (OR 1.13, 95% CI 1.03-1.23; P = 0.008) and minimal dilation of MPD (OR 11.3, 95% CI 2.40-53.65; P = 0.002) were associated with high-risk disease in Sendai-negative patients after multivariable risk adjustment. CONCLUSION The risk of harboring a high-risk disease remains low in small BD-IPMNs. However, Sendai-negative patients who are older than 65 years old and those with minimal dilation of MPD (3-5 mm) are at greater risk of high-risk lesions and should be given consideration to be included as a "worrisome feature" in a future guidelines update.
