Abstract
Since April 2011 we have been utilizing radial type endoscopic ultrasound (EUS) for diagnosis of pancreatic intraductal papillary mucinous neoplams (IPMN) at our hospital. Over this period, we have performed radial EUS in 22 patients with pancreatic IPMN. These patients were 13 men and 9 women with a mean age of 70 years old (41 to 80 years old) , including 2 cases with main duct type IPMN, 16 cases with branch duct type IPMN , and 4 cases with mixed type. EUS examination revealed a mural nodule of the cyst, in 9 of the 22 patients with pancreatic IPMN.
Due suspicion of malignancy after EUS, CT and MRI examinations, 10 patients were considered for surgical intervention. Of these, 6 patients underwent surgical resection.
In 9 cases were identified mural nodules in EUS examination. But in 7 cases of these 9 cases, could not detected mural nodules in CT or MRI examinations. It had been reported that the detection rate of mural nodules in pancreatic IPMN is 78% by EUS, 35% by conventional US, 24% by CT, and 19% by MRI. In terms of strategy for management of pancreatic IPMN, the existence of mural nodules is one of the high-risk factor for malignancy, and EUS is important and useful modality for the their diagnosis.
International consensus guidelines 2012 for the management of IPMN and mucinous cystic neoplasm (MCN) of the pancreas , EUS examination is recommended for patients with worrisome feature (cyst diameter greater than 30mm , main duct diameter 5-9 mm) , and for patients with cyst diameter greater than 20mm at follow up examinations. Using EUS, we were able to detect small mural nodule in cyst diameter from 15 mm, which is not regarded as high-risk stigmata or worrisome features according to the guidelines. We performed surgical resection of this lesion and it was diagnosed pathologically as intraductal papillary mucinous carcinoma (IPMC) . Therefore, although not currently recommended by international consensus guidelines, we would like to recommend EUS in patients with all pancreatic IPMN cysts.
We believe EUS evaluation is one of the most useful and significant modalities for management of patients with pancreatic IPMN.
