Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology

Ann Surg. 2007 Oct;246(4):644-51; discussion 651-4. doi: 10.1097/SLA.0b013e318155a9e5.


Objective: Determine whether size and other preoperative parameters predict malignant or invasive intraductal papillary mucinous neoplasia (IPMN).

Summary background data: From 1991 to 2006, 150 patients underwent 156 operations for IPMN.

Methods: Prospectively collected, retrospective review of a single academic institution's experience. All preoperative parameters including a detailed radiologic-based classification of IPMN type, location, distribution, size, number, cytology, and mural nodularity were correlated with IPMN pathology.

Results: Malignant IPMN was present in 32% of cases, whereas 19% of cases were invasive. IPMN type and main pancreatic duct diameter were significant predictors of malignant IPMN (P<0.001). Side-branch lesion number was negatively associated with invasive IPMN (P=0.03). Side-branch size, location, and distribution did not predict IPMN pathology. The presence of mural nodules was associated with malignant and invasive IPMN (P<0.001; P<0.02). Atypical cytopathology was significantly associated with malignant and invasive IPMN (P<0.001; P<0.001). Multivariate analysis demonstrated mural nodularity and atypical cytopathology were predictive of malignancy and/or invasion in branch-type IPMN.

Conclusions: To lower the rate of invasive pathology, surgery should be recommended for fit patients with main-duct IPMN and for branch-duct IPMN with mural nodularity or positive cytology irrespective of location, distribution, or size.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma, Mucinous / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Pancreatic Ductal / pathology*
  • Carcinoma, Papillary / pathology*
  • Cell Transformation, Neoplastic / pathology
  • Cohort Studies
  • Female
  • Forecasting
  • Humans
  • Laparoscopy
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Pancreatectomy
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / pathology*
  • Pancreaticoduodenectomy
  • Prospective Studies
  • Retrospective Studies
  • Survival Rate