Albert Gottfried Strauss MD, Presenter: Nothing to Disclose

Matthew Alexander Birdsey BMedSc, Abstract Co-Author: Nothing to Disclose

Bogata Dora Schwarz-Bundy, Abstract Co-Author: Nothing to Disclose

Stefan Fritz, Abstract Co-Author: Nothing to Disclose

Hans-Ulrich Kauczor MD, Abstract Co-Author: Research Grant, Boehringer Ingelheim GmbH Research Grant, Siemens AG Research Grant, Bayer AG Speakers Bureau, Boehringer Ingelheim GmbH Speakers Bureau, Siemens AG Speakers Bureau, Novartis AG

Lars Grenacher MD, Abstract Co-Author: Nothing to Disclose

Miriam Klauss MD, Abstract Co-Author: Nothing to Disclose

The radiological diagnosis of malignant IPMNs is controversial. The purpose of this study is to evaluate the current guidelines as a model to predict malignancy and to determine further predictors of malignancy.

384 patients that had preoperative imaging (CT/MRI) and had undergone a pancreatic operation with a resulting confirmed pathological diagnosis of IPMN were included in the study. Images were evaluated retrospectively by two independent radiologists using a standardized checklist including: size, location, presence of a solid component, lymphadenopathy, parenchymal atrophy, main pancreatic duct diameter and bile duct dilation (cholestasis). Descriptive statistics, binary logistic regression and ROC analysis were performed to assess the 2012 international consensus guidelines ('Sendai criteria') and other radiological predictors of malignancy.

Analysis of the current guidelines showed a diagnostic improvement with the addition of cholestasis to the “Sendai criteria” on determining malignancy of IPMNs (sensitivity 81.2% vs. 86.9% with no change in specificity of 59.6%). The largest single predictors of malignancy were solid components (OR 7.7) and cholestasis (OR 45.6). Over 95% of all cases with cholestasis had malignant IPMNs (PPV 96.4%; NPV 63.1%). The cause of cholestasis was not solely a result of direct compression of the bile duct by the lesions. Subanalysis of branch duct IPMNs (BD-IPMNs) also resulted in a diagnostic improvement with the addition of cholestasis (sensitivity 48.8% vs. 62.8% with no change in specificity of 76.4%). The largest single predictors of malignancy for BD-IPMNs were main pancreatic duct dilation (OR 8.1) and cholestasis (OR 72.2). Frequency analysis revealed that even small BD-IPMNs had already undergone malignant transformation (≤1cm: 15%; 1-2cm: 26% ; 2-3cm 20%) with about 10% of those having a dilated bile duct.

A dilated bile duct is a significant positive predictor of malignancy regardless of the size of the lesion. The addition of cholestasis to current guidelines is a superior tool for preoperative stratification of IPMNs.  

Improved radiological predictors of malignancy may offer better detection rates and in turn improved patient care.

Strauss, A, Birdsey, M, Schwarz-Bundy, B, Fritz, S, Kauczor, H, Grenacher, L, Klauss, M, Radiological Diagnosis of Malignant IPMNs: Refinement of the 2012 International Consensus Guidelines ('Sendai Criteria') with the Addition of Bile Duct Dilation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004545.html