Predicting malignant intraductal papillary mucinous neoplasm: a single-center review

Cone, Molly M.; Rea, Jennifer D.; Diggs, Brian S.; Douthit, Miriam A.; Billingsley, Kevin G.; Sheppard, Brett C.

doi:10.1016/j.amjsurg.2011.01.003

Cited by 18 publications

(12 citation statements)

References 23 publications

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“…The authors found that the positive predictive value in predicting a malignant branch-duct IPMN was low and that it was likely that some malignant lesions were missed based on the consensus guidelines. The authors also noted that experienced clinicians probably selected patients with an increased risk of malignancy based on various clinical factors such as tumor markers, age, previous medical history, or other unknown criteria [46,47,48]. Overall, the study of Goh et al [45] confirmed the limitations of the Sendai criteria for side-branch IPMNs.…”

Section: Treatment Recommendations For Branch-duct Ipmnssupporting

confidence: 65%

Pancreatic Intraductal Papillary Mucinous Neoplasm - Where Is the Challenge?

Fritz

Hackert

Büchler³

2014

Dig Dis

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Cystic lesions of the pancreas are increasingly recognized due to the widespread use of modern abdominal imaging technologies. The majority of these lesions display pseudocysts and mucinous cystic neoplasms. In contrast to pseudocysts, it is well established that mucinous cystic neoplasms of the pancreas exhibit a significant potential for malignant transformation over time. Among mucinous cystic tumors, the most frequently observed entity is pancreatic intraductal papillary mucinous neoplasm (IPMN). IPMNs are characterized by cystic dilation of pancreatic ducts and the production of mucus and by an adenoma-carcinoma sequence eventually culminating in invasive carcinoma in some patients. Due to the high risk of harboring malignancy, there is international consensus that IPMNs with involvement of the main pancreatic duct should be recommended for surgical resection. To date, the indication for surgery of branch-duct IPMNs is controversially discussed because of the overall lower risk of malignant transformation compared to main-duct IPMNs. Particularly for small and asymptomatic side-branch IPMNs, the indication for surgical resection remains challenging. In addition to the international consensus guidelines, a number of potential preoperative features predicting malignant transformation have been discussed recently. Moreover, novel surgical pancreatic parenchyma-sparing techniques such as enucleations or segmental pancreatic resections have been reported in order to treat IPMNs. The present article aims to demonstrate the current scientific knowledge in this field and to highlight the current controversy.

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Section: Treatment Recommendations For Branch-duct Ipmnssupporting

confidence: 65%

Pancreatic Intraductal Papillary Mucinous Neoplasm - Where Is the Challenge?

Fritz

Hackert

Büchler³

2014

Dig Dis

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“…7–11 In asymptomatic patients with SB-IPMN less than 3cm and absence of mural nodules, the risk of malignancy is in fact quite small, on the order of 0-5%. 12,13 As an increasing number of pancreatic cystic lesions are identified due to growing use of high-resolution imaging technology, one would expect a shift towards increased recognition of smaller and asymptomatic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Data from these series as well as additional studies which demonstrate that the risk of subsequent malignant transformation of such lesions is similarly quite low call into question the aggressive universal surveillance practices for small asymptomatic IPMN. 7–11 …”

Section: Discussionmentioning

confidence: 99%

The Clinical Relevance of the Increasing Incidence of Intraductal Papillary Mucinous Neoplasm

Klibansky

Reid‐Lombardo

Gordon

et al. 2012

Clinical Gastroenterology and Hepatology

142

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Background & Aims The incidence of intraductal papillary mucinous neoplasm (IPMN) is believed to be increasing; we investigated whether this is the result of increasing burden of disease or more diagnostic scrutiny. Methods In a retrospective cohort study, we calculated a trend in reported incidence of IPMN using data collected from Olmsted County, Minnesota from 1985 to 2005. Total IPMN cases from the Olmsted database were identified through keyword and ICD-9 search using a database from the Rochester Epidemiology Project, with all cases verified by subsequent chart review. The subsequent rate of IPMN-related carcinoma was calculated using data from the national SEER-9 database, reflecting trends from 1982 to 2007. Cases of IPMN-related carcinoma were identified in the SEER database by limiting the search to histology codes for non-invasive and invasive IPMN. Results Between 1985 and 2005, there was a 14-fold increase in the age and sex-adjusted incidence of IPMN, from 0.31 to 4.35 per 100,000 persons. From 2000 to 2001, the rate of reported carcinoma increased from .008 to .032 per 100,000 persons, but stabilized afterward, with a rate of .06 per 100,000 persons in 2007. Mortality from all causes of pancreatic cancer was stable between 1975 and 2007 (approximately 11 deaths per 100, 000 individuals). Conclusion The incidence of IPMN has increased in the absence of a rise in IPMN-related or overall pancreatic cancer-related mortality, so it likely results from an increase in diagnostic scrutiny, rather than greater numbers of patients with clinically relevant disease.

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“…1 IPMN is currently being diagnosed more frequently because of greater recognition and improved imaging modalities. Although IPMN is a common condition faced by practicing pancreatologists, previous studies have focused on the malignant potential of IPMN, [2][3][4][5][6] and relatively little is known about acute pancreatitis or acute recurrent pancreatitis (AP/ARP) patients with IPMN as the causative lesion. 7 Diagnosis of patients with AP/ARP caused by IPMN can be a challenge to clinicians because it is difficult to determine whether pancreatitis has been caused by IPMN.…”

Section: Introductionmentioning

confidence: 99%