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Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas
  1. Hiroyuki Uehara (uehara-hi{at}mc.pref.osaka.jp)
  1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Gastrointestinal Oncology, Japan
    1. Akihiko Nakaizumi
    1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cancer Survey, Japan
      1. Osamu Ishikawa
      1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Surgery, Japan
        1. Hiroyasu Iishi
        1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Gastrointestinal Oncology, Japan
          1. Koichi Tatsumi
          1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Gastrointestinal Oncology, Japan
            1. Rena Takakura
            1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cancer Survey, Japan
              1. Tetsushi Ishida
              1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cancer Survey, Japan
                1. Yasuna Takano
                1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cancer Survey, Japan
                  1. Sachiko Tanaka
                  1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cancer Survey, Japan
                    1. Akemi Takenaka
                    1. Osaka Medical Center for Cancer and Cardiovascular Diseases, Dept Cytology, Japan

                      Abstract

                      Background: Synchronous occurrence of intraductal papillary mucinous neoplasm (IPMN) and ductal carcinoma of the pancreas has been reported. Branch duct IPMNs with lower likelihood of malignancy are not submitted to resection but are followed up, so ductal carcinoma may develop during the follow-up. We investigated the development of ductal carcinoma of the pancreas during follow-up of branch duct IPMNs.

                      Patients and Methods: Sixty patients of branch duct IPMN that had intraductal tumor of less than 10mm on imaging examinations and negative result for malignancy in cytologic examination of pancreatic juice were investigated. They were followed up mainly by ultrasonography (US), and additionally by endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP) with cytologic examination of pancreatic juice for an average period of 87 months.

                      Results: Ductal carcinoma of the pancreas distinct from IPMN developed in 5 of 60 (8%) branch duct IPMNs during follow-up. 5-year rate of development of ductal carcinoma was 6.9% (95%CI 0.4-13.4%), incidence of ductal carcinoma was 1.1% (95%CI 0.1-2.2%) per year, and standardized incidence ratio of development of ductal carcinoma was 26 (95%CI 3-48). Patients over 70 years old developed ductal carcinoma significantly more frequently than those under 69. Four of 5 ductal carcinomas identified during follow-up were resectable. Cancer developed in IPMN in 2 of 60 (3%) branch duct IPMNs during follow-up.

                      Conclusions: During follow-up of branch duct IPMNs ductal carcinoma of the pancreas not infrequently developed apart from IPMN. In the follow-up of IPMN, special attention should be paid to the development of ductal carcinoma of the pancreas.

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