Erschienen in:
01.10.2013 | Pancreatic Tumors
Incidentally Discovered Pancreatic Intraepithelial Neoplasia: What Is Its Clinical Significance?
verfasst von:
Ioannis T. Konstantinidis, MD, Eduardo F. Vinuela, MD, Laura H. Tang, MD, David S. Klimstra, MD, Michael I. D’Angelica, MD, Ronald P. DeMatteo, MD, T. Peter Kingham, MD, Yuman Fong, MD, William R. Jarnagin, MD, Peter J. Allen, MD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 11/2013
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Abstract
Purpose
Pancreatic intraepithelial neoplasia (PanIN) is a presumed precursor of pancreatic ductal adenocarcinoma (PDAC). We assessed the relationship between incidental PanIN after resection of non-adenocarcinoma lesions and the development of metachronous PDAC in the remnant.
Methods
We retrospectively reviewed the clinicopathologic data of patients who underwent pancreatectomy for non-PDAC from January 2000 to January 2010. Intraductal papillary mucinous lesions were excluded. All available postoperative imaging and clinical follow-up data were reviewed; the risk of developing PDAC was assessed in patients with a minimum follow-up time of 6 months and with imaging studies available for review.
Results
A total of 584 patients were analyzed. Median age was 59 years (range 10–85 years), and 338 (58 %) were female. The most common lesions for which resection was performed were serous cystic neoplasms (17 %), pancreatic neuroendocrine tumors (38 %), metastatic tumors (9 %), and mucinous cystic neoplasms (7 %). PanIN was identified in 153 (26 %) patients. The majority of these patients had PanIN-1 or -2 (50 and 41 %, respectively), whereas 13 (8 %) had PanIN-3. Of the 506 (87 %) patients with adequate follow-up (median 3.7 years, range 0.5–12.6 years), 1 patient (0.2 %) with PanIN identified at the time of initial resection developed cancer in the remnant. This occurred 4.4 years after a distal pancreatectomy in the setting of PanIN-1B. No patient with PanIN-3 developed cancer during follow-up.
Conclusions
PanIN was identified in 26 % of patients who underwent resection for histopathology other than PDAC. The presence of PanIN of any grade did not result in an appreciable cancer risk in the pancreatic remnant after short-term follow-up.