Mariaemilia Traini

Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature?

Objectives: The management of branch‐duct IPMN remains controversial due to the relatively low rate of malignant degeneration and the uncertain predictive role of high‐risk stigmata (HRS) and worrisome features (WFs) identified by the 2012 International Consensus Guidelines. Our aim was to evaluate the evolution of originally lowrisk (Fukuoka‐negative) BD‐IPMNs during a long follow‐up period in order to determine whether the appearance of any clinical or morphological variables may be independently associated with the development of malignancy over time. Methods: A prospectively collected database of all patients with BD‐IPMN referring to our Institute between 2002 and 2016 was retrospectively analyzed. Univariate and multivariate analysis of association between changes during follow‐up, including appearance of HRS/WFs, and development of malignancy (high‐grade dysplasia/invasive carcinoma) was performed. Results: A total of 167 patients were selected for analysis, and seven developed malignant disease (4.2%). During a median follow‐up time of 55 months, HRS appeared in only three cases but predicted malignancy with 100% specificity. Worrisome features, on the other hand, appeared in 44 patients (26.3%). Appearance of mural nodules and MPD dilatation >5 mm showed a significant association with malignancy in multivariate analysis (p = 0.004 and p = 0.001, respectively). MPD dilatation in particular proved to be the strongest independent risk factor for development of malignancy (OR = 24.5). Conclusions: The risk of pancreatic malignancy in this population is low but definite. The presence of major WFs, and especially MPD dilatation, should prompt a tighter follow‐up with EUS and a valid cytological analysis whenever feasible.

Mo1348 Endobronchial Ultrasound (EBUS) in Esophageal and Esophagogastric Malignant Stenosis: an Added Value

Mo1347 Clinicopathologic Factors That Influence the Accuracy of HighFrequency Catheter EUS for Superficial Esophageal Carcinomas Bong Eun Lee, Gwang HA. Kim, Hyun Jeong Lee*, Dong Hoon Baek, Geun Am Song Pusan National University Hospital, Busan, Republic of Korea Aim: To assess the accuracy of endoscopic ultrasonography (EUS) conducted with a high-frequency (20 MHz) catheter probe for determining the depth of superficial esophageal carcinoma (SEC), and to identify clinicopathologic factors that influence the accuracy of EUS for differentiating mucosal and submucosal lesions. Methods: A total of 126 patients with endoscopically suspected SEC, who underwent EUS and curative treatment at Pusan National University Hospital during 2005-2013, were enrolled. We reviewed the medical records of 126 patients and compared EUS findings with histopathologic results according to the clinicopathologic factors. Results: A total of 114 lesions in 113 patients were included in the final analysis. EUS assessment of tumor invasion depth was accurate in 78.9% (90/114) patients. Accuracy did not differ according to histologic type, tumor differentiation, tumor location, or macroscopic shape. However, accuracy significantly decreased for tumors R3 cm in size (p Z 0.002). Overestimation and underestimation for the invasion depth was found in 11 lesions (9.6%) and in 13 lesions (11.4%), respectively. In multivariate analyses, tumor size R3 cm was the only factor significantly associated with EUS accuracy (P Z 0.031), and was specifically associated with underestimation of true invasion depth. Conclusion: EUS using a high-frequency catheter probe generally provides highly accurate assessment of the SEC invasion depth. However, accuracy decreases for tumors R3 cm, suggesting that caution is warranted when selecting treatments for such tumors according to pretreatment EUS staging.