Article
Significance of DNA index for differentiation between IPMN adenoma (IPMN A) and IPMN borderline type (IPMN B)
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Published: | March 21, 2014 |
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Introduction: Cystic pancreas lesions like intraductal papillary mucinous neoplasm (IPMN) are diagnosed more often. The indication for resection is usually provided by sectional imaging and specific criteria, for example Sendai criteria. The aim of this study was to analyze the importance of the DNA index / ploidy grade by differentiation between IPMN adenoma (IPMN A) and IPMN borderline type (IPMN B).
Material and methods: 16 patients underwent pancreatic resection due to an IPMN. In addition to the routine histopathologic analysis DNA-index and DNA ploidy grade were determined, using the DNA image cytometry. The histopathologic findings and the preoperative Sendai criteria were compared with the results of DNA analysis.
Results: 4 cases of IPMN A and 12 cases of IPMN B were performed. In the total cohort 8 patients had the main duct type IPMN and further 8 the branch type IPMN. All patients with IPMN B showed an aneuploide histogram with DNA indices ≥ 1.3 (1.3 - 1.5), whereas all patients with IPMN A showed an euploide histogram with DNA indices ≤ 1.3 (1.0 - 1.3). In the subcollective with IPMN B 5 patients showed a branch type IPMN. Only one patient with IPMN B performed all three Sendai criteria. Three further patients with IPMN B showed two Sendai criteria. All other patients with IPMN B showed only one or none Sendai criterion.
Conclusion: In the diagnosis of IPMN the determination of DNA index is a useful diagnostic extend. In our patient collective the ploidy index correlated exactly with the histopathological picture (aneuploidy = IPMN B) and was significantly superior to the Sendai criteria. Therefore the image DNA cytometry may represent a useful diagnostic extend by the indication and in the monitoring of patients with IPMN.