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MRI Characteristics of Invasive Intraductal Tubulopapillary Neoplasms versus Intraductal Papillary Mucinous Neoplasms of the Pancreas
Xu Fang1, Yun Bian1, Hui Jiang2, Li Wang1, Chengwei Shao1, and Jianping Lu1
1Radiology, Changhai Hospital of Shanghai, Shanghai, China, 2Pathology, Changhai Hospital of Shanghai, Shanghai, China

Synopsis

Keywords: Pancreas, Pancreas

Motivation: Differentiation between ITPNs and IPMNs is important because even ITPNs with an invasive component are associated with a better prognosis than invasive IPMNs. Potentially targetable genetic alterations in ITPNs and reveal new therapeutic targets for patients with ITPN.

Goal(s): Aimed to compare the MRI characteristics of ITPN and IPMN of the pancreas to differentiate between these two types of invasive carcinomas.

Approach: Preoperative MR images of pathologically confirmed ITPN and IPMN were retrospectively reviewed.

Results: Age, 2-tone duct sign and none cysitc lesion were independent predictors for invasive ITPN.

Impact: The combined model based on MRI characteristics shows high diagnostic performance.

Objective

This study aimed to compare the MRI characteristics of invasive intraductal tubulopapillary neoplasm (ITPN) and invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

Methods

Preoperative MR images of pathologically confirmed invasive ITPN and IPMN were retrospectively reviewed. 28 patients (16 males and 12 females; mean age, 57.25 ± 8.14 years) had invasive ITPN, and 68 patients (45 males and 23 females; mean age, 63.56 ± 7.89 years) had invasive IPMN. Two independent observers blinded to the pathological findings compared the MRI characteristics of the two groups. The t test and chi-square tests were used to determine differences between the two groups. Risk factors associated with invasive ITPN were assessed by multivariate analyses, and apparent performance was assessed according to the ability to discriminate patients with the two groups. The combined model was constructed by two groups of characteristics, and the diagnostic efficiency of the model was evaluated by receiver operating characteristic curve (ROC).

Results

Age, main pancreas duct (MPD) diameter, the presence of an intraductal solid component, 2-tone duct sign, no change in caliber of upstream MPD, pancreatic atrophy and none cysitc lesion were significantly associated with invasive ITPN (P < 0.05). Multivariate analysis revealed that age (OR:1.11, 95%CI:1.02, 1.21, P=0.02), 2-tone duct sign (OR:5.54, 95%CI:1.22, 25.17, P=0.03) and none cysitc lesion (OR:10.13, 95%CI:1.52, 62.78, P=0.02) were independent predictors for invasive ITPN. The area under the curve (AUC) values were 0.70, 0.80 and 0.65, respectively. The sensitivity and specificity of these three characteristics were 91.20% and 42.90%, 91.20% and 67.90%, 89.30% and 41.20%, respectively. The combined model yielded a highest AUC of 0.87, and sensitivity and specificity were 88.20% and 78.60%, respectively.

Conclusion

Age, 2-tone duct sign and none cysitc lesion were independent predictors for invasive ITPN. The combined model based on MRI characteristics is helpful to distinguish invasive ITPN and invasive IPMN, and shows high diagnostic performance.

Acknowledgements

None.

References

1. Kuan LL, Dennison AR, Garcea G. Intraductal Tubulopapillary Neoplasm of the Pancreas and Bile Duct: A Review. Pancreas. 2020; 49:498-502.

2. Yamaguchi H, Kuboki Y, Hatori T, et al. Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas. Am J Surg Pathol. 2011; 35:1812-1817.

3. Kim H, Ro JY. Intraductal Tubulopapillary Neoplasm of the Pancreas: An Overview. Arch Pathol Lab Med. 2018; 142:420-423.

4. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020; 76:182-188.

5. Basturk O, Berger MF, Yamaguchi H, et al. Pancreatic intraductal tubulopapillary neoplasm is genetically distinct from intraductal papillary mucinous neoplasm and ductal adenocarcinoma. Mod Pathol. 2017; 30:1760-1772.

6. Date K, Okabayashi T, Shima Y, et al. Clinicopathological features and surgical outcomes of intraductal tubulopapillary neoplasm of the pancreas: a systematic review. Langenbecks Arch Surg. 2016; 401:439-447.

7. Koh YX, Chok AY, Zheng HL, et al. Systematic review and meta-analysis comparing the surgical outcomes of invasive intraductal papillary mucinous neoplasms and conventional pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2014; 21:2782-2800.

8. Marchegiani G, Andrianello S, Dal Borgo C, et al. Adjuvant chemotherapy is associated with improved postoperative survival in specific subtypes of invasive intraductal papillary mucinous neoplasms (IPMN) of the pancreas: it is time for randomized controlled data. HPB (Oxford). 2019; 21:596-603.

9. Motosugi U, Yamaguchi H, Furukawa T, et al. Imaging studies of intraductal tubulopapillary neoplasms of the pancreas: 2-tone duct sign and cork-of-wine-bottle sign as indicators of intraductal tumor growth. J Comput Assist Tomogr. 2012; 36:710-717.

10. Kim HJ, Park MS, Chung T, et al. Multimodality imaging studies of intraductal tubulopapillary neoplasms of the pancreas. Diagn Interv Radiol. 2019; 25:251-256.

11. Zhang J, Ren S, Wang J, et al. Imaging findings of intraductal tubulopapillary neoplasm (ITPN) of the pancreas: Two case reports and literature review. Medicine (Baltimore). 2019; 98:e14426.

12. Basturk O, Adsay V, Askan G, et al. Intraductal Tubulopapillary Neoplasm of the Pancreas: A Clinicopathologic and Immunohistochemical Analysis of 33 Cases. Am J Surg Pathol. 2017; 41:313-325.

13. Lee JE, Choi SY, Min JH, et al. Determining Malignant Potential of Intraductal Papillary Mucinous Neoplasm of the Pancreas: CT versus MRI by Using Revised 2017 International Consensus Guidelines. Radiology. 2019; 293:134-143.

14. Jokoji R, Tsuji H, Tsujimoto M, et al. Intraductal tubulopapillary neoplasm of pancreas with stromal osseous and cartilaginous metaplasia; a case report. Pathol Int. 2012; 62:339-343.

15. Takayama S, Maeda T, Nishihara M, et al. A case of intraductal tubulopapillary neoplasm of pancreas with severe calcification, a potential pitfall in diagnostic imaging. Pathol Int. 2015; 65:501-506.

16. Perez-Johnston R, Narin O, Mino-Kenudson M, et al. Frequency and significance of calcification in IPMN. Pancreatology. 2013; 13:43-47.

17. Tsujimae M, Masuda A, Shiomi H, et al. Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms. J Gastroenterol Hepatol. 2019; 34:1648-1655.

18. Javadi S, Menias CO, Korivi BR, et al. Pancreatic Calcifications and Calcified Pancreatic Masses: Pattern Recognition Approach on CT. AJR Am J Roentgenol. 2017; 209:77-87.

Figures

A 51-year-old female patient showing ITPN with invasive ductal adenocarcinoma of the pancreas. A Contrast-enhanced portal venous phase MR image shows an intraductal solid component occupying the dilated main pancreatic duct of the pancreatic body and tail, and the 2-tone duct sign between the tumor and fluid (arrow). B T2WI image shows the 2-tone duct sign between the tumor and fluid (arrow). C Macroscopic examination shows solid tumor diffusely occupying the dilated main pancreatic duct. D Microscopic examination shows an intraductal solid tumor without mucus secretion (HE, 20×).

A 57-year-old female patient showing ITPN with invasive ductal adenocarcinoma of the pancreas. A~B Axial and coronal T2WI image show an intraductal solid component occupying the dilated main pancreatic duct of the pancreatic body, the 2-tone duct sign between the tumor and fluid (arrow). C Contrast-enhanced portal venous phase MR image shows the tumor was confined to the main pancreatic duct, without extraductal invasion (arrow). D Microscopic examination shows an intraductal solid tumor without mucus secretion and extraductal invasion (HE, 20×).

A 73-year-old male patient showing IPMN with invasive ductal adenocarcinoma of the pancreas. A~B Axial T2WI images show a solid component with extraductal invasion in the pancreatic head (arrow). C Coronal T2WI image shows the cystic lesion located below the solid component (arrow). D~E Contrast-enhanced portal venous phase MR image shows the solid component with mild enhancement and extraductal invasion (arrow). F Microscopic examination shows florid papillary projections in the dilated main pancreatic duct and extraductal ductal adenocarcinoma (arrow) (HE, 20×).

Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)
4143
DOI: https://doi.org/10.58530/2024/4143