Medical Research: What is the background for this study?
Dr. Wallace: Since its first consideration as an independent entity in 1996,1 intraductal papillary mucinous neoplasms (IPMN) of the pancreas have been diagnosed with increasing frequency. Detection and resection of IPMN offer a unique opportunity to cure and prevent adenocarcinoma of the pancreas, an otherwise highly lethal disease. The main clinical concern related to intraductal papillary mucinous neoplasms is its wide-ranging potential for malignancy from low-risk indolent lesions to those with high incidence of malignant degeneration. It is well-established that this malignant progression varies based on the morphological subtypes. The current methods of predicting malignant potential are limited to clinical, morphological, and cyst fluid cytology and biomarker data.
Medical Research: What are the main findings?
Dr. Wallace: Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed no statistically significant association between cancer/high-grade dysplasia and gender, age or alcohol consumption. Smoking history and body mass index was significantly related with cancer/ high-grade dysplasia. Jaundice and steatorrhea were also associated with cancer/ high-grade dysplasia; however, weight loss was not. Univariate analysis showed no association between malignancy and the cyst number/location, although a strong association was shown for cyst size. The presence/size of nodules, and main duct involvement were strongly related with malignancy.
Medical Research: What should clinicians and patients take away from your report?
Dr. Wallace: Small cystic lesions of the pancreas are common and most will not progress to cancer. A subset of these may carry higher risk and should be monitored closely or resected. This is include large (> 3-4cm) cysts, those with mural nodules, and those associated with dilations of the main pancreatic duct. Symptoms which suggest a higher risk lesion include jaundice, and steatorrhea (fatty/oily stools). Smoking and obesity are also modifiable risk factors.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Wallace: Despite these important clinical predictors, we still need more accurate methods. Currently the focus is on genomic profiling of cyst tissue obtained by fine needle biopsy and whole exome sequencing. Minimally invasive (laparoscopic) and even endoscopic ablation techniques are increasingly available and may offer lower risk options for therapy.
Maria Moris, Massimo Raimondo, Timothy A. Woodward, Verna Skinner, Paolo G. Arcidiacono, Maria C. Petrone, Claudio De Angelis, Selene Manfrè, Pietro Fusaroli, Michael B. Wallace
Received: January 7, 2015; Accepted: March 9, 2015; Published Online: April 10, 201
MedicalResearch.com Interview with:, & Michael B. Wallace, M.D., MPH (2015). Which Pancreatic Cysts Carry Malignant Potential