Comparative study on the clinical and imaging characteristics of intraductal tubulopapillary neoplasms and intraductal papillary mucinous neoplasms of the pancreas
Objective To investigate the differences in the clinical and imaging characteristics between intraductal tubularpapillary neoplasm of the pancreas(ITPN)and intraductal papillary mucinous neoplasm of pancreas(IPMN).Methods From January 26,2015 to October 31,2023,at the First Affiliated Hospital of Naval Medical University(Shanghai Changhai Hospital),the clinical,pathological and imaging datas of 28 patients with ITPN and 68 patients with IPMN pathologically diagnosed after surgical resection were retrospectively analyzed.The clinical characteristics included age,gender,body mass index,presence or absense of jaundice,history of pancreatitis and surgical methods.Imaging features included the type of pancreatic duct involved by the tumor,location of the tumor,diameter of the main pancreatic duct(MPD)and common bile duct,location of solid components of the tumor,2-tone duct sign of the MPD,morphology of the MPD upstream of the tumor,pancreatic atrophy,presence or absense of cystic lesions,calcification,and duodenum invasion.Multivariate logistic regression was performed to analyze independent predictive factors of ITPN and establish a diagnostic model.The receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated.Independent sample t-test,rank-sum test and chi-square test were used for statistical analysis.Results All the patients with ITPN and IPMN had invasive cancer which was composed of ductal adenocarcinoma.The age of the patients with ITPN was younger than that of the patients with IPMN((57.2±8.1)years old vs.(63.6±7.9)years old);the diameter of MPD of patients with ITPN was larger than that of the patients with IPMN(12.00(8.00,14.50)mm vs.9.00(6.00,11.00)mm);the proportions of the solid tumor component confined within intraductal of pancreas(82.1％,23/28 vs.27.9％,19/68),2-tone duct sign of the MPD(67.9％,19/28 vs.8.8％,6/68),and pancreatic atrophy(71.4％,20/28 vs.47.1％,32/68)were all higher than those of patients with IPMN;and the proportions of abrupt change in caliber of upstream MPD and cystic lesions were both lower than those of patients with IPMN(25.0％,7/28 vs.60.3％,41/68;10.7％,3/28 vs.41.2％,28/68);the differences were all statistically significant(t=-3.53,Z=-2.34,x2=23.68,35.89,4.74,9.88 and 7.08;all P＜0.05).The results of multivariate logistic regression analysis showed that age,2-tone duct sign of the MPD,and absence of cystic lesions were independent predictive factors of ITPN(HR=1.11,5.54,10.13,95％confidence interval(95％CI)1.02 to 1.21,1.22 to 25.17,1.52 to 62.78,respectively;all P＜0.05).The AUC of the model distinguishing ITPN and IPMN established with the combination of the above 3 independent predictive factors was 0.87(95％CI 0.79 to 0.95)with a sensitivity of 88.2％and with a specificity of 78.6％.Conclusion Age,2-tone duct sign of the MPD,and absence of cystic lesions are independent predictive factors of ITPN and IPMN,and the differential diagnosis model shows good diagnostic efficacy.
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