Original article—liver, pancreas, and biliary tractMorphologic Changes in Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Midterm Follow-Up Study
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Inclusion Criteria
All consecutive patients diagnosed in our department from January 1999 to August 2005 with highly suspected IPMN confined to BD were considered for inclusion in this study. Diagnosis was highly suspected when patients with normal MPD had 1 or several BD dilatation(s) or pancreatic cystic lesions communicating with pancreatic ducts, observed with at least 2 of the following imaging techniques: CT scan, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), or EUS.
Exclusion Criteria
We excluded patients from
Characteristics of the Overall Population
Among the 189 patients diagnosed with strongly suspected IPMN confined to BD, 52 were excluded because of follow-up periods of less than 1 year. Sixteen additional patients were excluded because of thickening of the duct wall or a mural nodule (n = 13) or BD dilatation of more than 30 mm (n = 3) was present at diagnosis. The study included 121 patients whose characteristics are summarized in Table 1. Twenty-four of these patients also were included in the study by Levy et al.4
Radiologic Data at Diagnosis
A median number of
Discussion
In 1999, we decided not to perform surgery on patients without or with mildly symptomatic IPMN confined to BD in the absence of radiologic criteria suggesting malignancy. This decision was made based on the low percentage of IPMN-carcinoma in situ or invasive carcinoma observed in the pathologic samples of patients with IPMN that only involved BD. Prophylactic pancreatectomy clearly was inappropriate and too aggressive in these patients.9, 10, 26 The present article evaluates the morphologic
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