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Safety and efficacy of microwave ablation for periductal hepatocellular carcinoma with Intraductal cooling of the central bile ducts through a percutaneous transhepatic cholangial drainage tube

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Journal of Interventional Medicine 2019年第2期2卷 84-90页

作者： Naijian Ge Jian Huang Zhiyong Shi Xiaohe Yu Shuqun Shen Xiaobing Wu Jing Zhou Qinqin Hang Yefa Yang Mini-invasive Intervention Center Eastern Hepatobiliary Surgery HospitalThe Second Military Medical University225 Changhai RoadShanghaiChina The No.1 Department of Biliary Surgery Eastern Hepatobiliary Surgery HospitalThe Second Military Medical University225 Changhai RoadShanghaiChina Medical Department Health Insurance Office Eastern Hepatobiliary Surgery HospitalThe Second Military Medical University225 Changhai RoadShanghaiChina

Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that Intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the Intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with Intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p valueIntraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does

关键词： Microwave ablation Hepatocellular carcinoma Biliary complications Intraductal cooling technique Percutaneous transhepatic cholangial drainage

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Increased risk of second malignancy in pancreatic Intraductal papillary mucinous tumors: Review of the literature

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World Journal of Gastroenterology 2015年第23期21卷 7313-7319页

作者： Gian Luca Baiocchi Sarah Molfino Barbara Frittoli Graziella Pigozzi Federico Gheza Giacomo Gaverini Antonio Tarasconi Chiara Ricci Francesco Bertagna Luigi Grazioli Guido AM Tiberio Nazario Portolani Department of Medical and Surgical Sciences Surgical Clinic University of Brescia 1~(st) Department of Radiology Brescia Civil Hospital Department of Medical and Surgical Sciences Gastroenterological Unit University of Brescia Department of Surgical Specialties Radiological and Forensic Sciences Nuclear Medicine SectionUniversity of Brescia

AIM: To analyze the available evidence about the risk of extrapancreatic malignancies and pancreatic ductal adenocarcinoma associated to pancreatic Intraductal papillary mucinous tumors(IPMNs).METHODS: A systematic search of literature was undertaken using MEDLINE, EMBASE, Cochrane and Web-of-Science libraries. No limitations for year of publication were considered; preference was given to English papers. All references in selected articles were further screened for additional publications. Both clinical series and Literature reviews were selected. For all eligible studies, a standard data extraction form was filled in and the following data were extracted: study design, number of patients, prevalence of pancreatic cancer and extrapancreatic malignancies in IPMN patients and control groups, if available.RESULTS: A total of 805 abstracts were selected and read; 25 articles were considered pertinent and 17 were chosen for the present systematic review. Eleven monocentric series, 1 multicentric series, 1 casecontrol study, 1 population-based study and 3 case report were included. A total of 2881 patients were globally analyzed as study group, and the incidence of pancreatic cancer and/or extrapancreatic malignancies ranged from 5% to 52%, with a mean of 28.71%.When a control group was analyzed(6 papers), the same incidence was as low as 9.4%.CONCLUSION: The available Literature is unanimous in claiming IPMNs to be strongly associated with pancreatic and extrapancreatic malignancies. The consequences in IPMNs management are herein discussed.

关键词： Intraductal papillary mucinous neoplasm Pancreas Diagnosis Follow-up Tumors Computedtomography scan 18FDG-PET

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Validation and head-to-head comparison of four models for predicting malignancy of Intraductal papillary mucinous neoplasm of the pancreas: A study based on endoscopic ultrasound findings

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World Journal of Gastrointestinal Oncology 2019年第11期11卷 1043-1053页

作者： Jie Hua Bo Zhang Xiu-Jiang Yang Yi-Yin Zhang Miao-Yan Wei Chen Liang Qing-Cai Meng Jiang Liu Xian-Jun Yu Jin Xu Si Shi Department of Pancreatic Surgery Fudan University Shanghai Cancer CenterDepartment of OncologyFudan University Shanghai Medical CollegeShanghai Pancreatic Cancer InstituteShanghai 200032China Department of Endoscopy Fudan University Shanghai Cancer CenterShanghai 200032China

BACKGROUND Several models are currently available for predicting the malignancy of pancreatic Intraductal papillary mucinous neoplasm(IPMN),namely,the Pancreatic Surgery Consortium(PSC),the Japan Pancreas Society(JPS),the Johns Hopkins Hospital(JHH),and the Japan-Korea(JPN-KOR)models.However,a head-to-head comparison that shows which model is more accurate for this individualized prediction is lacking.AIM To perform a head-to-head comparison of the four models for predicting the malignancy of pancreatic IPMN.METHODS A total of 181 patients with IPMN who had undergone surgical resection were identified from a prospectively maintained database.The characteristics of IPMN in patients were recorded from endoscopic ultrasound imaging data and report archives.The performance of all four models was examined using Harrell’s concordance index(C-index),calibration plots,decision curve analyses,and diagnostic tests.RESULTS Of the 181 included patients,94 were categorized as having benign disease,and the remaining 87 were categorized as having malignant disease.The C-indexes were 0.842[95%confidence interval(CI):0.782-0.901],0.704(95%CI:0.626-0.782),0.754(95%CI:0.684-0.824),and 0.650(95%CI:0.483-0.817)for the PSC,JPS,JHH,and JPN-KOR models,respectively.Calibration plots showed that the PSC model had the least pronounced departure from ideal predictions.Of the remaining three models,the JPS and JHH models underestimated the probability of malignancy,while the JPN-KOR model overestimated the malignant potential of branch duct-IPMN.Decision curve analysis revealed that the PSC model resulted in a better clinical net benefit than the three other models.Diagnostic tests also showed a higher accuracy(0.801)for the PSC model.CONCLUSION The PSC model exhibited the best performance characteristics.Therefore,the PSC model should be considered the best tool for the individualized prediction of malignancy in patients with pancreatic IPMN.

关键词： Intraductal papillary mucinous neoplasms Prediction model Endoscopic ultrasound Mural nodules Malignancy

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International guidelines for the management of pancreatic Intraductal papillary mucinous neoplasms

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World Journal of Gastroenterology 2015年第34期21卷 9833-9837页

作者： Brian KP Goh Department of Hepatopancreatobiliary and Transplant Surgery Singapore General Hospital Duke -National University of Singapore Graduate Medical School

The management of Intraductal papillary mucinous neoplasms(IPMN) is presently evolving as a result of the improved understanding of the natural history and biological behavior of the different pancreatic cystic neoplasms; and better preoperative diagnosis of these neoplasms due to advancement in preoperative diagnostic tools. International consensus guidelines for the management of IPMN were first formulated in 2006 and subsequently revised in 2012. Both these guidelines were constructed based on expert opinion and not on robust clinical data. The main limitation of the original Sendai guidelines was that it had a low positive predictive value resulting in many benign neoplasms being resected. Hence,these guidelines were revised in 2012. However,although the updated guidelines resulted in an improvement in the positive predictive value over the Sendai Guidelines,the results of several studies validating these guidelines demonstrated that its positive predictive value remained low. Furthermore,although both guidelines were associated with high negative predictive values,several investigators have demonstrated that some malignant IPMNs may be missed. Finally,it is imperative to emphasize that major considerations when managing a patient with IPMN including the patient's surgical risk,life-expectancy and even cost of investigations are not taken into account in current guidelines. The management of a patient with IPMN should be individualized and tailored according to a patient's risk benefit profile for resection vs surveillance.

关键词： Intraductal papillary mucinous neoplasms Pancreati

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Intraductal papillary bile duct adenocarcinoma and gastrointestinal stromal tumor in a case of neurofibromatosis type 1

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World Journal of Gastroenterology 2018年第4期24卷 537-542页

作者： Jung Min Lee Jae Min Lee Jong Jin Hyun Hyuk Soon Choi Eun Sun Kim Bora Keum Yoon Tae Jeen Hoon Jai Chun Hong Sik Lee Chang Duck Kim Dong Sik Kim Joo Young Kim Division of Gastroenterology and Hepatology Department of Internal Medicine Institute of Gastrointestinal Medical Instrument Research Korea University College of Medicine Division of Gastroenterology and Hepatology Department of Internal Medicine Korea University Anam Hospital Division of HBP Surgery and Liver Trans- plantation Department of Surgery Korea University College of Medicine Department of Pathology Korea University College of Medicine

We report our experience with a synchronous case of gastrointestinal stromal tumor(GIST) and Intraductal papillary neoplasm of the bile duct(IPNB) in anelderly woman with neurofibromatosis type 1(NF-1). A 72-year-old woman presented with a 2-mo history of right upper abdominal pain unrelated to diet and indigestion. Fourteen years earlier, she had been diagnosed with NF-1, which manifested as café au lait spots and multiple nodules on the skin. Computed tomography(CT) revealed a multilocular low-density mass with septation, and mural nodules in the right hepatic lobe, as well as a 1.7-cm-sized well-demarcated enhancing mass in the third portion of the duodenum. The patient subsequently underwent right hepatectomy and duodenal wedge resection. We present here the first report of a case involving a synchronous IPNB and GIST in a patient with NF-1. Our findings demonstrate the possibility of various tumors in NF-1 patients and the importance of diagnosis at an early

关键词： Neurofibromatosis type 1 Intraductal papillary neoplasm of the bile duct Gastrointestinal stromal tumor Synchronous

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Differential diagnosis of benign and malignant branch duct Intraductal papillary mucinous neoplasm using contrastenhanced endoscopic ultrasonography

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World Journal of Gastroenterology 2015年第20期21卷 6252-6260页

作者： Hirofumi Harima Seiji Kaino Shuhei Shinoda Michitaka Kawano Shigeyuki Suenaga Isao Sakaida Department of Gastroenterology and Hepatology Yamaguchi University Graduate School of Medicine

AIM: To elucidate the role of contrast-enhanced endoscopic ultrasonography(CE-EUS) in the diagnosis of branch duct Intraductal papillary mucinous neoplasm(BD-IPMN).METHODS: A total of 50 patients diagnosed with BDIPMN by computed tomography(CT) and endoscopic ultrasonography(EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules(MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis.RESULTS: Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS(median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BDIPMN to 93%. CONCLUSION: Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.

关键词： Contrast-enhanced endoscopic ultrasonography Endoscopic ultrasonography Computedtomography Branch duct Intraductal papillary mucinousneoplasm Mural nodules

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Outcomes of nonresected main-duct Intraductal papillary mucinous neoplasms of the pancreas

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World Journal of Gastroenterology 2015年第9期21卷 2658-2667页

作者： Mathieu Daudé Fabrice Muscari Camille Buscail Nicolas Carrère Philippe Otal Janick Selves Louis Buscail Barbara Bournet Department of Gastroenterology CHU Toulouse RangueilUniversity of Toulouse31059 ToulouseFrance Department of Digestive Surgery CHU Toulouse Rangueil and PurpanUniversity of Toulouse31059 ToulouseFrance Department of Public Health and Epidemiology CHU Rennes PontchaillouUniversity of Rennes35033 RennesFrance Department of Radiology CHU Toulouse RangueilUniversity of Toulouse31059 ToulouseFrance Department of Pathology CHU Toulouse PurpanUniversity of Toulouse31300 ToulouseFrance

AIM:To compare characteristics and outcomes of resected and nonresected main-duct and mixed Intraductal papillary mucinous neoplasms of the pancreas(IPMN).METHODS:Over a 14-year period,50 patients who did not undergo surgery for resectable main-duct or mixed IPMN,for reasons of precluding comorbidities,age and/or refusal,were compared with 74 patients who underwent resection to assess differences in rates of survival,recurrence/occurrence of malignancy,and prognostic factors.All study participants had dilatation of the main pancreatic duct by ≥ 5 mm,with or without dilatation of the branch ducts.Some of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle aspiration.For the surgical patients,pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic duct.Clinical and biologic follow-ups were conducted for all patients at least annually,through hospitalization or consultation every six months during the first year of follow-up,together with abdominal imaging analysis(magnetic resonance cholangiopancreatography or computed tomography) and,if necessary,endoscopic ultrasound with or without fine needle aspiration.RESULTS:The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients(74% vs 58%; P =0.019).The parameters of age( 10 mm,branch ductdiameter > 30 mm,or presence of extra pancreatic cancers did not significantly influence the prognosis.In the nonsurgical patients,pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo(median:29 mo; range:8-141 mo).Comparison of the nonsurgical patients who experienced disease progression with those who did not progress showed no signi

关键词： Main-duct Intraductal papillary mucinous neoplasms

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Intraductal papillary neoplasm of the bile ducts: A case report and literature review

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World Journal of Gastroenterology 2015年第43期21卷 12498-12504页

作者： Yaohong Tan Clara Milikowski Yanelba Toribio Adam Singer Claudia P Rojas Monica T Garcia-Buitrago Department of Pathology Jackson Memorial HospitalUniversity of Miami Miller School of Medicine Department of Radiology Jackson Memorial HospitalUniversity of Miami Miller School of Medicine

Intraductal papillary neoplasm of the bile duct(IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries,it is very rare and the etiology is unknown. In this article,we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-yearold female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB,gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of Pub Med database,we collected 354 IPNB patients reported in 22 articles. In these patients,52.8% were from Japan and 27.7% were from western countries including the United States(11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically,57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically,pancreato-biliary subtype accounted for 41.8%,intestinal 28.0%,gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies,diagnosis of IPNB is still challenging,especially in western countries due to its rarity. Defined clinicopathologic features are in demand for the accurate diagnosis and proper treatment.

关键词： Intraductal papillary neoplasm Mucinous cystic neo

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Simultaneous liver mucinous cystic and Intraductal papillary mucinous neoplasms of the bile duct:A case report

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World Journal of Gastroenterology 2014年第14期20卷 4102-4105页

作者： Agnieszka Budzynska Marek Hartleb Ewa Nowakowska-Dulawa Robert Krol Piotr Remiszewski Michal Mazurkiewicz Department of Gastroenterology and Hepatology Medical University of Silesia Department of General Vascular and Transplant SurgeryMedical University of Silesia Department of General Transplant and Liver SurgeryMedical University of Warsaw Department of Pathological Anatomy Medical University of Warsaw

Cystic hepatic neoplasms are rare tumors,and are classified into two separate entities:mucinous cystic neoplasms(MCNs)and Intraductal papillary mucinous neoplasms of the bile duct(IPMN-B).We report the case of a 56-year-old woman who presented with abdominal pain and jaundice due to the presence of a large hepatic multilocular cystic tumor associated with an Intraductal tumor.Partial hepatectomy with resection of extrahepatic bile ducts demonstrated an intrahepatic MCN and an Intraductal IPMN-B.This is the first report of the simultaneous occurrence of these two histologically distinct entities in the liver.

关键词： Liver Mucinous cystic neoplasm Intraductal papilla

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Intraductal papillary neoplasm of the bile duct

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World Journal of Gastroenterology 2013年第46期19卷 8595-8604页

作者： Xue-Shuai Wan Yi-Yao Xu Jun-Yan Qian Xiao-Bo Yang An-Qiang Wang Lian He Hai-Tao Zhao Xin-Ting Sang Department of Liver Surgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

Intraductal papillary neoplasm of the bile duct(IPNB)is a variant of bile duct carcinoma that is characterized by Intraductal growth and better outcomes compared with common cholangiocarcinoma.IPNBs are mainly found in patients from Far Eastern areas,where hepatolithiasis and clonorchiasis are endemic.According to the immunohistochemical profiles of the mucin core proteins,IPNBs are classified into four types:pancreaticobiliary,intestinal,gastric,and oncocytic.Approximately 40%-80%of IPNBs contain a component of invasive carcinoma or tubular or mucinous adenocarcinoma,suggesting that IPNB is a disease with high potential for malignancy.It is difficult to make an accurate preoperative diagnosis because of IPNB’s low incidence and the lack of specificity in its clinical manifestation.The most common abnormal preoperative imaging findings of IPNB are Intraductal masses and the involvement of bile duct dilation.Simultaneous proximal and distal bile duct dilation can be detected in some cases,which has diagnostic significance.Cholangiography and cholangioscopy are needed to confirm the pathology and demonstrate the extent of the lesions.However,pathologic diagnosis by biopsy cannot reflect the actual stage in many cases because different foci may be of different stages and because mixed pathologic findings may exist in the same lesion.Surgical resection is the major treatment.Systematic cholangioscopy with staged biopsies and frozen sections is recommended during resection to ensure that no minor tumors are left and that curative resection is achieved.Staging,histologic subtype,curative resection and lymph node metastasis are factors affecting long-term survival.

关键词： Intraductal neoplasm Papillary cholangio-carcinoma Biliary papillomatosis Mucinous Prognosis

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