目的:考虑恶性肿瘤的临床放射学高危预测因素,对手术切除的胰腺粘液性囊性肿瘤(MCN)和分支导管型乳头状粘液性肿瘤(BD-IPMN)进行比较分析。
方法:224例接受手术切除并经组织病理学证实为MCNs(良性73;恶性17)或BD-IPMNs(良性110;恶性24)并进行了术前CT或MRI检查的患者。分类为高度异型增生或浸润性癌的肿瘤被认为是恶性的,而低度发育不良的患者被认为是良性的。影像学特征由两名放射科医师基于所选择的高风险柱头进行分析,或由普遍指南提出的令人担忧的特征,除了具有主胰管扩张(>5mm)的肿瘤被排除。
结果:MCNs和BD-IPMNs在肿瘤大小等方面表现出显著差异,location,增强壁画结节的存在和大小,壁或间隔增厚的存在,和多重性。多因素分析显示肿瘤大小(OR,1.336;95%CI,1.124-1.660,p=0.002)和增强壁结节的存在(OR,67.383;95%CI,4.490-1011.299,p=0.002)是恶性MCNs的显著预测因子。良、恶性肿瘤的最佳肿瘤大小为8.95cm,灵敏度为70.6%,89%的特异性,PPV为27.6%,净现值为96.9%,表现出优于指南建议的阈值4.0cm的特异性。对于恶性BD-IPMNs,增强壁画结节的存在(OR,15.804;95%CI,4.439-56.274,p<0.001)和CA19-9升高(OR,19.089;95CI,2.868-127.068,p=0.002)作为恶性预测因子,具有5.5mm的增强壁结节阈值的大小,可提供最佳的恶性分化。
结论:虽然目前的指南可能适用于管理BD-IPMN,我们的结果显示,恶性MCNs的最佳阈值明显大于当前指南所建议的阈值.这需要重新考虑现有的MCN初始风险分层和管理指南阈值。
OBJECTIVE: To perform a comparative analysis of surgically resected mucinous cystic neoplasm (MCN) of pancreas and branch-duct type intraductal papillary mucinous neoplasms (BD-IPMN) considering clinico-radiological high-risk predictors for malignant tumors using the current management
guidelines.
METHODS: 224 patients who underwent surgical resection and had histopathologically confirmed MCNs (benign 73; malignant 17) or BD-IPMNs (benign 110; malignant 24) and had pre-operative CT or MRI were retrospectively reviewed. Tumors classified as either high-grade dysplasia or invasive carcinoma were considered malignant, whereas those with low-grade dysplasia were considered benign. Imaging features were analyzed by two radiologists based on selected high-risk stigmata or worrisome features proposed by prevalent
guidelines except tumors with main pancreatic duct dilatation (> 5 mm) were excluded.
RESULTS: MCNs and BD-IPMNs showed significant differences in aspects like tumor size, location, the presence and size of enhancing mural nodules, the presence of wall or septal thickening, and multiplicity. Multivariate analyses revealed tumor size (OR, 1.336; 95% CI, 1.124-1.660, p = 0.002) and the presence of enhancing mural nodules (OR, 67.383; 95% CI, 4.490-1011.299, p = 0.002) as significant predictors of malignant MCNs. The optimal tumor size differentiating benign from malignant tumor was 8.95 cm, with a 70.6% sensitivity, 89% specificity, PPV of 27.6%, and NPV of 96.9%, demonstrating superior specificity than the
guideline-suggested threshold of 4.0 cm. For malignant BD-IPMNs, the presence of enhancing mural nodules (OR, 15.804; 95% CI, 4.439-56.274, p < 0.001) and CA 19 - 9 elevation (OR, 19.089; 95%CI, 2.868-127.068, p = 0.002) as malignant predictors, with a size of enhancing mural nodule threshold of 5.5 mm providing the best malignancy differentiation.
CONCLUSIONS: While current
guidelines may be appropriate for managing BD-IPMNs, our results showed a notably larger optimal threshold size for malignant MCNs than that suggested by current guidelines. This warrants reconsidering existing
guideline thresholds for initial risk stratification and management of MCNs.