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Optimal Surveillance Interval of Branch Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas
Youngmin Han1, Wooil Kwon1, Mirang Lee1
1Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
JAMA Surgery
|January 17, 2024
Summary
Surveillance for branch duct intraductal papillary mucinous neoplasm (BD-IPMN) can be tailored based on cyst size and initial changes. Small BD-IPMNs without worrisome features may allow for surveillance discontinuation after 5 years.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Pancreatic Diseases
Background:
- Intraductal papillary mucinous neoplasm (IPMN) prevalence is rising, yet long-term data on growth and malignant conversion rates are limited.
- Current international guidelines recommend surveillance for benign IPMN lesions, but optimal intervals and duration remain undefined.
Purpose of the Study:
- To establish an optimal surveillance protocol for IPMN.
- To identify patients who may be suitable for exemption from surveillance.
Main Methods:
- A large-scale, international cohort study analyzed data from 3656 patients with branch duct IPMN (BD-IPMN) across 5 tertiary pancreatic centers.
- Follow-up data from 1988-2020 were assessed for cyst size changes, worrisome features, high-risk stigmata, and malignant conversion rates.
- Patients with BD-IPMN were monitored per International Association of Pancreatology guidelines, with surgical resection for suspicious lesions.
Main Results:
- Optimal surveillance intervals for BD-IPMN may be 1.5, 1, and 0.5 years for cysts <20 mm, 20-30 mm, and >30 mm, respectively, after initial 6-month follow-up.
- Malignant conversion occurred in 4.7% of patients.
- Patients with <20 mm cysts, no worrisome features, and no growth over 5 years showed no malignant conversion and had a >10-year time to progression.
Conclusions:
- BD-IPMN surveillance strategies should consider cyst size and morphologic changes identified at the initial 6-month follow-up.
- Surveillance may be discontinued for patients with small cysts (<20 mm) exhibiting no changes over 5 years, particularly if they are unfit for surgery or have a limited life expectancy.
