• Annals of surgery · Jun 2022

    Significance of Uncinate Duct Dilatation in IPMNs: A New High-risk Criterion?

    • Samer S AlMasri, Mazen S Zenati, Anil Dasyam, Aatur D Singhi, Kenneth K Lee, David L Bartlett, Adam Slivka, Kevin Mcgrath, Jennifer Chennat, Kenneth E Fasanella, Asif Khalid, Randall E Brand, Savreet Sarkaria, Rohit Das, Melissa E Hogg, Herbert J Zeh, Alessandro Paniccia, and Amer H Zureikat.
    • Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
    • Ann. Surg. 2022 Jun 1; 275 (6): e789-e795.

    ObjectiveTo evaluate the significance of UDD in IPMNs.BackgroundThe uncinate process of the pancreas has an independent ductal drainage system. International consensus guidelines of IPMNs still consider it as a branch-duct, even though it is the main drainage system for the uncinate process.MethodsA retrospective review of all surgically treated IPMNs at our institution after 2008 was performed. Preoperative radiological studies were reviewed by an abdominal radiologist who was blinded to the pathological results. In addition to the Fukuoka criteria, presence of UDD was recorded. Using multivariate analysis, the pathological significance of UDD in predicting advanced neoplasia [high grade dysplasia or invasive carcinoma (HGD/ IC)] was determined.ResultsTwo hundred sixty patients were identified (mean age at diagnosis was 68 years and 49% were females): 122 (47%) had HGD/IC. UDD was noted in 59 (23%), of which 36 (61%) had HGD/IC (P < 0.003). On multivariate analysis, UDD was an independent predictor of HGD/IC (odds ratio = 2.99, P < 0.04). Subgroup analysis on patients with IPMNs confined to the dorsal portion of the gland (n = 161), also demonstrated UDD to be a significant predictor of HGD/IC in those remote lesions (odds ratio: 4.41, P = 0.039).ConclusionsThis is the largest study to evaluate the significance of UDD in IPMNs and shows it to be a high-risk feature. This association persisted for remote IPMNs limited to the dorsal pancreas, suggesting UDD may be associated with an aggressive phenotype even in remote IPMN lesions.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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