ABSTRACT
Objective: To discuss the feasibility of distinguishing benign from malignant intraductal papillary mucinous tumors (IPMT) of the pancreas preoperatively based on the clinical and radiological characteristics. Methods: The clinical data of 40 patients with IPMT treated between July 1996 and March 2007 were analyzed. The diagnoses of all patients were confirmed pathologically after surgical resections. Among the 40 patients, there were 17 benign cases and 23 malignant ones. Results: Malignant IPMT patients had a higher frequency of upper abdominal pain and jaundice than benign patients (P<0.05). The sex difference in incidence of IPMT, time of onset, and loss of body mass were not significantly different between the 2 groups. Radiological results demonstrated that the size of tumor and mural nodules in the lesions were larger in the malignant cases than in the benign cases (P<0.05); besides, the malignant cases also had a more dilated main pancreatic duct (MPD) (P<0.05). Mural nodules and thick irregular septum in the cystic lesions were more frequently seen in malignant cases (P<0.05). There was no significant difference in the site preference between the 2 groups. Conclusion: Benign and malignant IPMT have significant differences in their clinical and radiological characteristics, which provides an important evidence for differentiating the biological types of IPMT and helps surgeons on their decision of surgical planning.
ABSTRACT
Objective: To evaluate the value of intraductal ultrasonography (IDUS) in diagnosis of pancreatic diseases. Methods: We retrospectively reviewed the imaging data of 63 patients with pancreatic diseases who underwent IDUS from February 2005 to February 2010. A 20 MHz over-the-guidewire intraductal US catheter probe was used during endoscopic retrograde cholangio- pancreatography(ERCP) for further examination of the pancreas. We also compared the results of CT, magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) and abdominal ultrasonography in diagnosis of pancreatic diseases, so as to further evaluate the value of IDUS in the clinical diagnosis of pancreatic diseases. Results: The accuracies of IDUS in diagnosis of chronic pancreatitis (23 cases), pancreatic cancer (10 cases), intraductal papillary mucinous tumors (IPMT, 25 cases), and pancreatic adenoma (4 cases) were 93. 7% (59/63), 100.0% (63/63), 90.5% (57/63), and 96.8% (61/63), and the Kappa values were 0.854, 1.00, 0.898, and 0.848, respectively. The diagnostic accuracies and Kappa test values of IDUS were better than those of the other four methods. IDUS correctly diagnosed the pancreatic cystadenocarcinoma in one patient before operation. Conclusion: IDUS has a high diagnostic value for pancreatic diseases.
ABSTRACT
Objective To summarize the clinical features of intraductal papillary mucinous tumors (IPMT) of the pancreas to improve the diagnosis and treatment of IPMT.Methods The clinical features,imaging features and clinicopatholagic characteristics of 49 IPMT patients,who underwent operations in our department from March 1996 to September 2008,were retrospectively analyzed.The clinical features of benign,borderline and malignant IPMT were compared.Results Among the 49 patients,there were 27 males and 22 females;the average age was 58±11 years.There were 18 benign cases,9 borderline cases and 22 malignant ones.The difference in sex ratio,age of disease onset,smoking and drinking habit,history of pancreatitis and diabetes,presence of abdominal pain,radiation pain,abdominal bloating and weight loss symptoms,serum levels of CEA,AST,ALT,tumor location and type were not significantly different between the 3 groups.However,there were significant difference in term of jaundice,serum carbohydrate antigen 19-9(CA19-9)and alkaline phosphatase (AKP) levels,size of tumor,diameter of main pancreatic duct,presence of septum in cystic tumor,mural modules in the tumor.Among the malignant IPMT patients,one patient died 5 years after operation,one patient had malignancy recurrence;among the benign and borderline IPMT patients,1 patient had malignancy recurrence and 1 patient died due to other disease.Conclusions Different types of IPMT had different clinical features and comprehensive judgment were needed to differentiate.