BACKGROUND A mural module (MN) within a branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) could be a potential target for local treatment. The main aim was to describe the location of the highest grade of dysplasia relative to the mural module to assess the relevance of local treatment. METHODS Observational study of patients who underwent a pancreatic resection for suspected high-risk IPMN because of a mural module within a BD-IPMN (2012-2022). All patients had preoperative imaging confirming the enhancing mural module. The mural module was considered as a theoretical appropriate target for local destruction if no cancer or high-grade dysplasia (HGD) was described elsewhere than in the mural module. RESULTS Eighty-two patients (male: 44 (54%); mean age: 65 ± 9.2 years) were included. The mean size of BD-IPMN containing the mural module was 32 ± 14.8 mm. The mural module mean diameter was 10.5 ± 5.6 mm, and the main pancreatic duct (MPD) mean diameter was 5.2 ± 3.6 mm. Six patients presented invasive carcinoma (7%), 37 had HGD (45%), and 39 (48%) had exclusively low-grade dysplasia. The mural module was dysplastic in 70 cases (85%). The mural module was considered a relevant target for local ablation in 45 patients (55%), whereas 37 patients (45%) had HGD/invasive carcinoma distant from the mural module. HGD was exclusively present in the mural module in 6/82 patients (7%). Factors independently associated with 'relevant indication for local treatment' were female gender (P = 0.004; OR = 5.2, 95% c.i. 1.7 to 15.9) and MPD < 5 mm (P < 0.0001; OR = 8.6, 95% c.i. 2.7 to 26.8). CONCLUSION In resected pancreata, BD-IPMN mural modules are associated with HGD distant from the mural module almost half of cases. The findings question the safety of local treatment, supporting pancreatectomy as the best approach.

中文翻译：

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接受切除的胰腺分支管导管内状粘液性肿瘤的壁结节和高度异型增生的患病率。


背景 分支管内状粘液性肿瘤 （BD-IPMN） 内的壁画模块 （MN） 可能是局部治疗的潜在靶点。主要目的是描述相对于壁画模块最高等级异型增生的位置，以评估局部治疗的相关性。方法 对因 BD-IPMN 内的壁模块而接受胰腺切除术的患者进行观察性研究 （2012-2022）。所有患者术前影像学检查证实了增强壁模块。如果壁画模块以外的其他地方没有描述癌症或高度发育不良 （HGD），则壁画模块被认为是理论上适合的局部破坏目标。结果 共纳入 82 例患者 （男性： 44 （54%）;平均年龄： 65 ± 9.2 岁）。包含壁画模块的 BD-IPMN 的平均尺寸为 32 ± 14.8 毫米。壁画模块平均直径为 10.5 ± 5.6 mm，主胰管 （MPD） 平均直径为 5.2 ± 3.6 mm。6 例患者表现为浸润性癌 （7%），37 例患有 HGD （45%），39 例 （48%） 完全患有低度异型增生。壁画模块在 70 例 （85%） 中发育不良。壁画模块被认为是 45 例患者 （55%） 局部消融的相关靶点，而 37 例患者 （45%） 患有远离壁画模块的 HGD/浸润性癌。HGD 仅存在于 6/82 例患者的壁画模块中 （7%）。与“局部治疗的相关适应症”独立相关的因素是女性 （P = 0.004;OR = 5.2,95% CI 1.7 至 15.9）和 MPD < 5 mm（P < 0.0001;OR = 8.6,95% CI 2.7 至 26.8）。结论 在切除的胰腺中，BD-IPMN 壁画模块与远离壁画模块的 HGD 相关，几乎有一半的病例。 研究结果质疑局部治疗的安全性，支持胰腺切除术作为最佳方法。