Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation
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View abstract on PubMed
Summary
This summary is machine-generated.Discontinuing surveillance for branch duct intraductal papillary mucinous neoplasms (BD-IPMN) may be safe for select patients. Patients over 65 with stable cysts under 15mm can stop surveillance as cancer risk is similar to the general population.
Area Of Science
- Gastroenterology
- Oncology
- Epidemiology
Background
- Branch duct intraductal papillary mucinous neoplasms (BD-IPMN) surveillance incurs significant healthcare costs.
- Current surveillance protocols for BD-IPMN may offer questionable benefits for cancer prevention.
- Identifying patients at low risk for malignancy can justify surveillance discontinuation.
Purpose Of The Study
- To identify patients with BD-IPMN whose cancer risk is comparable to the general population.
- To establish criteria for discontinuing surveillance in low-risk BD-IPMN patients.
- To reduce healthcare costs associated with indefinite BD-IPMN surveillance.
Main Methods
- International multicenter study of presumed BD-IPMN without worrisome features or high-risk stigmata.
- Analysis of cyst size and stability for at least 5 years to define low-risk clusters.
- Comparison with age-matched controls using standardized incidence ratios (SIRs) for pancreatic cancer.
Main Results
- 1617 of 3844 patients (42%) remained stable without worrisome features or high-risk stigmata for ≥5 years.
- Patients ≥75 years old had an SIR of 1.12 (95% CI, 0.23-3.39).
- Patients ≥65 years old with stable cysts ≤15 mm after 5 years had an SIR of 0.95 (95% CI, 0.11-3.42).
Conclusions
- Pancreatic malignancy risk in stable BD-IPMN without worrisome features/high-risk stigmata is comparable to the general population.
- Surveillance discontinuation may be justified after 5 years of stability in patients ≥75 years with cysts <30 mm.
- Surveillance discontinuation may be justified in patients ≥65 years with stable cysts ≤15 mm.
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