{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:47:55Z","timestamp":1787014075674,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>A pancreatic cyst &gt;5\u2009mm in diameter that communicates with the dilated main pancreatic duct (MPD) \u22655\u2009mm on imaging is defined as mixed type intraductal papillary mucinous neoplasm (MX\u2010IPMN). However, the frequency of tumor involvement of the MPD in MX\u2010IPMN remains unknown. This study investigated how often MX\u2010IPMNs involve the MPD and whether MPD involvement can be diagnosed by peroral pancreatoscopy (POPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included patients who underwent POPS for MX\u2010IPMN followed by surgical resection between July 2018 and December 2021. The pathological features of MX\u2010IPMN, including tumor extension to the MPD, were analyzed. Additionally, the diagnostic performance of various imaging modalities in detecting tumor extension to the MPD was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among a total of 15 patients, 10 (67%) had pathologically confirmed tumor extension to the MPD. In most cases with pathologically confirmed MPD involvement, the main tumor was diagnosed as high\u2010grade dysplasia (60%) or invasive carcinoma (10%). Conversely, low\u2010grade dysplasia was the main lesion in most cases without MPD involvement (low\u2010grade dysplasia 80%; high\u2010grade dysplasia 20%, invasive carcinoma 0%). The diagnostic accuracy, sensitivity, and specificity of POPS with or without biopsy was 93.3%, 90.0%, and 100%, respectively. POPS demonstrated higher accuracy and sensitivity than computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (accuracy: 93.3%, 40%, 60%, and 80%; sensitivity: 93.3%, 10%, 40%, and 70%, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, 67% of MX\u2010IPMNs had pathologically proven MPD involvement. Tumor extension to the MPD is highly suspicious of malignancy, and POPS may be useful for evaluating MPD involvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.15051","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T05:50:31Z","timestamp":1749102631000},"page":"972-980","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["How often does a mixed type intraductal papillary mucinous neoplasm on imaging indicate pathological involvement of the main pancreatic duct?"],"prefix":"10.1111","volume":"37","author":[{"given":"Kosuke","family":"Takahashi","sequence":"first","affiliation":[{"name":"Third Department of Internal Medicine University of Toyama  Toyama Japan"},{"name":"Department of Gastroenterology and Hepatology Nagasaki University Graduate School of Biomedical Sciences  Nagasaki 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