Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

Abstract

Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

Nomogram to predict malignancy in branch duct type intraductal papillary mucinous neoplasms

“…The incidence of malignant BD-IPMNs and invasive carcinoma are 10.3% and 5.2% in our population which is lower than that in MPD involved IPMNs. Previous studies also indicated that the risk of cancer in BD-IPMNs is low (1%–2%) [ 6 , 19 ] which was slightly lower than our data. High risk malignant IPMNs (18%) or invasive carcinoma (7.5%) was also reported in several studies.…”

A retrospective study of intraductal papillary neoplasia of the pancreas (IPMN) under surveillance

“…Little evidence exists in the literature to guide the frequency, duration, and type of surveillance for IPMNs. 1,8 In 2015, American Gastroenterological Association (AGA) guidelines advocated for ceasing surveillance after BD-IPMN patients remained asymptomatic for 5 years. 9 By contrast, European guidelines recommend lifelong surveillance of patients fit for surgery.…”

“…However, the growing amount of IPMN patients under surveillance requires identifying a subpopulation of patients that are at the lowest risk of developing malignancy and who thus do not need annual follow-up. 8 In 2020, Ciprani et al demonstrated that cysts <15 mm at the time of diagnosis had a very low risk of malignant transformation, with that risk decreasing over time. 10 Furthermore, they argued that a size increase of ⩾2.5 mm/year represents the strongest predictor of malignancy.…”

The use of a smartphone application to disseminate guidelines on pancreatic cystic neoplasms

“…Notwithstanding the existence of expert consensus policies 1–3 regarding the management of pancreatic cystic neoplasms (PCNs) for more than a decade, the lack of data on guidelines application in the real word is a matter of concern 4,5 . If guidelines are not enforced in clinical practice, this can result in serious inequalities in terms of PCNs' management.…”

“…Notwithstanding the existence of expert consensus policies 1 , 2 , 3 regarding the management of pancreatic cystic neoplasms (PCNs) for more than a decade, the lack of data on guidelines application in the real word is a matter of concern. 4 , 5 If guidelines are not enforced in clinical practice, this can result in serious inequalities in terms of PCNs' management. Indeed, whereas most practitioners dealing with PCNs allege to know the available guidelines for their clinical practice, 6 which guidelines are chosen in specific clinical scenarios is yet unknown.…”