Intraductal papillary tumors of the pancreas: evaluation with endoscopic ultrasonography

Gastrointest Endosc. 1998 Aug;48(2):164-71. doi: 10.1016/s0016-5107(98)70158-0.


Background: We retrospectively analyzed the endoscopic ultrasonographic characteristics of intraductal papillary tumors of the pancreas and identified signs indicative of malignant tumors.

Methods: Twenty-eight patients with intraductal tumors and 38 with other pancreatic cystic lesions underwent endoscopic ultrasonography, conventional ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP).

Results: Intraductal tumors were classified into three subtypes, and endoscopic ultrasonographic characteristics were assessed. In main duct type tumors, the main pancreatic duct showed a segmental or diffuse moderate-to-marked dilatation, often associated with intraductal nodules. Pancreatic parenchymal atrophy was frequently recognized. Branch duct type tumors consisted of multiple 5 to 20 mm cysts with the appearance of a cluster of grapes. The main duct was mildly dilated or nondilated. Combined type tumors had features of both main duct and branch duct types. Endoscopic ultrasonography (92%) differentiated pancreatic cystic lesions more precisely than ultrasonography (82%) and ERCP (89%). Main duct or combined type tumors, large tumors (> or = 30 mm for branch duct type), marked dilatation of the main pancreatic duct (> or = 10 mm for other types), and mural nodules suggested malignancy. Endoscopic ultrasonography demonstrated these signs more accurately than ultrasonography or ERCP.

Conclusion: Endoscopic ultrasonography is useful for diagnosing intraductal papillary tumors, particularly for predicting malignancy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Carcinoma / diagnostic imaging*
  • Cholangiopancreatography, Endoscopic Retrograde
  • Diagnosis, Differential
  • Endosonography* / instrumentation
  • Endosonography* / methods
  • Endosonography* / statistics & numerical data
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Cyst / diagnostic imaging
  • Pancreatic Ducts / diagnostic imaging*
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Pseudocyst / diagnostic imaging
  • Retrospective Studies
  • Statistics, Nonparametric