A recent update on the morphological classification of intraductal papillary neoplasm of the bile duct: Correlation with postoperative prognosis and pathological features.

Abstract

We proposed a novel morphological classification for intraductal papillary neoplasm of the bile duct (IPNB) and evaluated its association with postoperative prognosis. Forty-two IPNB patients who underwent surgical resection were classified morphologically into three types-branched (n = 10), main duct (n = 26), and mixed (n = 6)-based on preoperative imaging features indicating cystic and/or bile duct involvement. Among them, 32 patients with evaluable specimens were further categorized pathologically into Type 1 (n = 10) and Type 2 (n = 22). Patient characteristics and postoperative outcomes were analyzed. Intraepithelial neoplasia was more frequently observed in the branched type, whereas invasive carcinoma predominated in the main duct type. In the mixed type, a half of patients involved both intra- and extrahepatic bile ducts, and this type also showed the highest incidence of residual tumor. The mixed type had the poorest 5-year postoperative survival rate (50%), compared to 90% in the main duct type and 100% in the branched type. It also exhibited the highest 5-year recurrence rate (62%). Among IPNB patients with associated invasive carcinoma, tumor infiltration beyond the bile duct wall (p < 0.001) and lymph node metastasis (p = 0.021) were significantly associated with poor prognosis, whereas the anatomical extent of the lesion (intrahepatic, extrahepatic, or both) was not. Morphological classification was significantly correlated with pathological subtypes: the branched type was predominant in Type 1 (60%), while the main duct type predominated in Type 2 (64%) (p = 0.039). Our novel morphological classification of IPNB correlates with postoperative prognosis and may assist in preoperative planning of surgical strategies for IPNB patients.