Intraductal Papillary Mucinous Neoplasm of the Pancreas: The Role of Intraductal Ultrasonography in Selection of Resection Method of Pancreas

Background/Aims: The treatment of choice of intraductal papillary mucinous neoplasm (IPMN) is partial pancreatic resection with complete excision of this potentially malignant lesion, thus preserving sufficient pancreatic tissue to ensure endocrine and exocrine functions. This strategy, however, requires a reliable preoperative assessment of the highly variable extension of IPMN. We performed this study to determine the role of intraductal ultrasonography (IDUS) in predicting the extension of IPMN and selecting the resection methods of pancreas. Methods: A preoperative assessment of IPMN by IDUS was performed in 12 patients who underwent a surgical resection of IPMN. According to the preoperative localization of IPMN by IDUS, various types of limited pancreatic resections were planned. The histologic examination of the frozen section of the pancreatic cut surface was performed in all patient. In the cases of tumor involvement as cut surface margin, a modification of the planned pancreatic resection was done. Results: Technical success was achieved in all 12 cases (100%). There were positive tumor margin of cut surfaces in 2 patients. Of 10 cases whose frozen tissue evaluation of the pancreatic cut surface had been negative at first, one patieat has turned out to be margin positive in permanent section examination, finally. Overall accuracy of IDUS in predicting the continuous extension of IPMN was75%. Conclusions: IDUS is a reliable diagnostic modality to guide the resection extent of the pancreas in patients with IPMN.