Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine
<b>Background:</b> In patients with BD-IPMN, surgical indications have been focused on finding malignant lesions (HGD, high-grade dysplasia/IC, invasive carcinoma). The aim of this study was to compare the preoperative factors that distinguish HGD from LGD (low-grade dysplasia) and HGD f...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/13/1/149 |
| _version_ | 1797440090621870080 |
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| author | Ji Eun Na Jae Keun Park Jong Kyun Lee Joo Kyung Park Kwang Hyuck Lee Kyu Taek Lee |
| author_facet | Ji Eun Na Jae Keun Park Jong Kyun Lee Joo Kyung Park Kwang Hyuck Lee Kyu Taek Lee |
| author_sort | Ji Eun Na |
| collection | DOAJ |
| description | <b>Background:</b> In patients with BD-IPMN, surgical indications have been focused on finding malignant lesions (HGD, high-grade dysplasia/IC, invasive carcinoma). The aim of this study was to compare the preoperative factors that distinguish HGD from LGD (low-grade dysplasia) and HGD from IC to find the optimal pathologic target for surgery according to individuals, considering surgical risks and outcomes. <b>Methods:</b> We retrospectively analyzed 232 patients with BD-IPMN diagnosed based on pathology after surgery and preoperative images. The primary outcome was identifying preoperative factors distinguishing HGD from LGD, and HGD from IC. <b>Results:</b> In patients with LGD/HGD, a solid component or an enhancing mural nodule ≥ 5 mm (OR = 9.29; 95% CI: 3.3–54.12; <i>p</i> < 0.000) and thickened/enhancing cyst walls (OR = 6.95; 95% CI: 1.68–33.13; <i>p</i> = 0.008) were associated with HGD. In patients with malignant lesions (HGD/IC), increased serum CA 19-9 (OR = 12.59; 95% CI: 1.81–87.44; <i>p</i> = 0.006) was associated with IC. <b>Conclusions</b>: The predictive factors for HGD were the presence of a solid component or an enhancing mural nodule ≥ 5 mm and thickened/enhancing cyst walls compared with LGD, and if accompanied by increased CA 19-9, it might be necessary to urgently evaluate the lesion due to the possibility of progression to IC. Based on this finding, we need to find HGD as the optimal pathologic target for surgery to improve survival in low-surgical-risk patients, and IC could be assumed to be the optimal pathologic target for surgery in high-surgical-risk patients because of high morbidity and mortality associated with surgery. |
| first_indexed | 2024-03-09T12:02:06Z |
| format | Article |
| id | doaj.art-d42d9d0fa8be4293a6b083d628040caa |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T12:02:06Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-d42d9d0fa8be4293a6b083d628040caa2023-11-30T23:02:48ZengMDPI AGJournal of Personalized Medicine2075-44262023-01-0113114910.3390/jpm13010149Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized MedicineJi Eun Na0Jae Keun Park1Jong Kyun Lee2Joo Kyung Park3Kwang Hyuck Lee4Kyu Taek Lee5Department of Medicine, Inje University Haeundae Paik Hospital, Busan 48108, Republic of KoreaDepartment of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea<b>Background:</b> In patients with BD-IPMN, surgical indications have been focused on finding malignant lesions (HGD, high-grade dysplasia/IC, invasive carcinoma). The aim of this study was to compare the preoperative factors that distinguish HGD from LGD (low-grade dysplasia) and HGD from IC to find the optimal pathologic target for surgery according to individuals, considering surgical risks and outcomes. <b>Methods:</b> We retrospectively analyzed 232 patients with BD-IPMN diagnosed based on pathology after surgery and preoperative images. The primary outcome was identifying preoperative factors distinguishing HGD from LGD, and HGD from IC. <b>Results:</b> In patients with LGD/HGD, a solid component or an enhancing mural nodule ≥ 5 mm (OR = 9.29; 95% CI: 3.3–54.12; <i>p</i> < 0.000) and thickened/enhancing cyst walls (OR = 6.95; 95% CI: 1.68–33.13; <i>p</i> = 0.008) were associated with HGD. In patients with malignant lesions (HGD/IC), increased serum CA 19-9 (OR = 12.59; 95% CI: 1.81–87.44; <i>p</i> = 0.006) was associated with IC. <b>Conclusions</b>: The predictive factors for HGD were the presence of a solid component or an enhancing mural nodule ≥ 5 mm and thickened/enhancing cyst walls compared with LGD, and if accompanied by increased CA 19-9, it might be necessary to urgently evaluate the lesion due to the possibility of progression to IC. Based on this finding, we need to find HGD as the optimal pathologic target for surgery to improve survival in low-surgical-risk patients, and IC could be assumed to be the optimal pathologic target for surgery in high-surgical-risk patients because of high morbidity and mortality associated with surgery.https://www.mdpi.com/2075-4426/13/1/149optimal pathologic target for surgeryBD-IPMNlow-grade dysplasiahigh-grade dysplasiainvasive carcinoma |
| spellingShingle | Ji Eun Na Jae Keun Park Jong Kyun Lee Joo Kyung Park Kwang Hyuck Lee Kyu Taek Lee Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine Journal of Personalized Medicine optimal pathologic target for surgery BD-IPMN low-grade dysplasia high-grade dysplasia invasive carcinoma |
| title | Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine |
| title_full | Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine |
| title_fullStr | Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine |
| title_full_unstemmed | Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine |
| title_short | Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine |
| title_sort | comparison of clinical and imaginal features according to the pathological grades of dysplasia in branch duct intraductal papillary mucinous neoplasm bd ipmn for personalized medicine |
| topic | optimal pathologic target for surgery BD-IPMN low-grade dysplasia high-grade dysplasia invasive carcinoma |
| url | https://www.mdpi.com/2075-4426/13/1/149 |
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