Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up

Abstract

A mural nodule of 10 mm is appropriate as an indicator of surgery in the follow-up of branch duct IPMN.

Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis

“…On the other hand, high-risk stigmata, including jaundice, malignant cytology and dilated MPD, were strongly associated with malignancy and decreased survival. We failed to identify enhancing nodules, a well-known feature associated with invasive carcinoma in IPMNs,6 9–10 28 32 as an independent predictor of survival in all the analysis carried out in the study. This observation, however, should be considered with caution because the study is retrospective, and overall nodules and enhancing nodules were identified in only 48 (17%) and 22 patients (8%), respectively, and it is possible that the presence of nodules at diagnosis had prompted clinicians to operate patients without any delay.…”

Accuracy of 2012 International Consensus Guidelines for the prediction of malignancy of branch-duct intraductal papillary mucinous neoplasms of the pancreas

“…With an overall risk of malignant transformation estimated at 6-40%, a close surveillance of BD-PMN seems reasonable except if predictive factors of malignancy are present or appear during follow-up. [2][3][4][5][6][7] In order to propose a management algorithm of BD-IPMN, the International Consensus Guidelines (ICG) have been updated recently in 2012 and categorized predictors of malignancy as high-risk stigmata and worrisome features. 8 High-risk stigmata include (a) obstructive jaundice, (b) enhanced solid component, and (c) dilation of the main pancreatic duct (MD) to a diameter greater than 10 mm.…”

Stromal Fibrosis and Expression of Matricellular Proteins Correlate With Histological Grade of Intraductal Papillary Mucinous Neoplasm of the Pancreas

“…10,26,27 Among these characteristics, a large mural nodule is considered to be the most reliable predictive factor. 27,28 The present study is the first to indicate that fibrosis and the expression of matricellular proteins in the periductal stroma are useful for predicting the histological grade of IPMN. Based on these results, the histological grade of IPMN with marked stromal fibrosis is more likely to be high-grade dysplasia or IPMN with an associated invasive carcinoma.…”