Intraductal Papillary Mucinous Neoplasm and Pancreatic Cancer: Opportunity Knocks Twice

Pancreatic cystic lesions are widely recognized as harbingers of pancreatic cancer. Intraductal papillary mucinous neoplasm (IPMN) is the most common type of cystic lesion, offering promising avenues for early diagnosis of pancreatic cancer. Although IPMN has a well-established malignant potential, the wide variation in cancer risk necessitates prolonged surveillance for most patients. There is an unmet need to optimize surveillance strategies for patients with IPMNs to address the rising global mortality associated with pancreatic cancer and to balance early cancer detection against healthcare resource allocation. While published guidelines outline common risk factors of carcinoma derived from IPMN, the resource-intensive nature of surveillance underscores the need for more granular management strategies-a need not yet reflected in current recommendations. Moreover, it is important to appreciate that patients with IPMNs also face an elevated risk of developing pancreatic carcinoma arising concomitantly with IPMN. This type of carcinoma presents unique challenges for surveillance but also offers novel opportunities for the timely identification of incident pancreatic cancer. Recent advances in diagnostic modalities, including endoscopic ultrasound-guided biomarker analysis and artificial intelligence-based image analysis, hold promise for improving risk stratification and carcinoma diagnosis. This review highlights current evidence and future perspectives on the clinical management of patients with IPMNs, with a particular focus on the dual opportunities for surveillance. Optimizing strategies for the early detection of both carcinoma derived from IPMN and carcinoma concomitant with IPMN has the potential to meaningfully reduce the burden of pancreatic cancer.