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Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) continue to be an area of interest given the high frequency with which they are discovered (usually as incidental findings on cross-sectional imaging) and the uncertainty around their optimal management. A recent retrospective analysis from Korea provides the largest dataset yet available on risk for malignant progression of these lesions.
The study included nearly 1400 patients who showed classical features of BD-IPMNs on cross-sectional imaging at a single center. After a minimum follow-up of 3 years (median, 61 months), results were as follows:
The median annual growth rate of BD-IPMNs was 0.8 mm.
Forty-six patients (3%) required surgery because of disease progression; median follow-up time in these patients was 62 months.
High-risk features were observed in 15% of patients and included cyst size ≥3 cm (overall frequency, 8%), main pancreatic duct dilatation (6%), thickened cyst walls (4%), and mural nodule (3%).
In addition to the annual rate of cyst growth, main pancreatic duct dilatation and mural nodules were associated with larger cyst size.
Han Y et al. Progression of pancreatic branch duct intraductal papillary mucinous neoplasm associates with cyst size. Gastroenterology 2017 Oct 23; [e-pub]. (http://dx.doi.org/10.1053/j.gastro.2017.10.013)
Comment
This study further solidifies the notion that while most BD-IPMNs have a low rate of transformation, a small but relevant portion of patients who harbor these lesions will progress to developing high-risk lesions that can require surgery, and progression correlates with neoplasm size. The fact that many of these lesions took years to become worrisome suggests that surveillance in these patients is a long-term proposition that will require significant attention and generate substantial cost.