Validation of the American Gastroenterological Association guidelines on management of intraductal papillary mucinous neoplasms: more than 5 years of follow-up

Imbe, Koh; Nagata, Naoyoshi; Hisada, Yuya; Takasaki, Yusuke; Sekine, Katsunori; Mishima, Saori; Kawazoe, Akihito; Tajima, Tsuyoshi; Shimbo, Takuro; Yanase, Mikio; Akiyama, Junichi; Fujimoto, Kazuma; Uemura, Naomi

doi:10.1007/s00330-017-4966-x

Cited by 21 publications

(27 citation statements)

References 21 publications

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“…9 In a Japanese study involving 159 patients with branch-duct IPMNs followed for >5 years, 3 (1.9%) of 159 patients developed pancreatic carcinoma. 41 As consistent with these studies, the current study has demonstrated a substantial rate of pancreatic carcinogenesis after 5-year surveillance, providing evidence supporting prolonged surveillance of patients with branch-duct IPMNs. A further investigation is warranted taking into account cost-effectiveness of surveillance programs, invasiveness of surgical resection of the pancreas, and patients' quality of life.…”

Section: Discussionsupporting

confidence: 87%

“…38,39 Conversely, accumulating evidence suggests that patients with branch-duct IPMNs may remain at high risk of developing pancreatic carcinoma after 5-year surveillance. 9,[40][41][42] Few large studies have examined pancreatic carcinogenesis associated with branch-duct IPMNs specifically among patients with no considerable change during 5-year surveillance. In a study at a US referral center, high-grade dysplasia and invasive carcinoma were observed in 20 (5.5%) and 16 (4.4%) patients, respectively, of 363 patients included at the time of 5 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2020

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BACKGROUND & AIMS: Long-term outcomes of patients with branch-duct intraductal papillary mucinous neoplasms (IPMNs), particularly those after 5 years of surveillance, have not been fully evaluated in large studies. We analyzed incidences of IPMN-derived carcinoma and concomitant ductal adenocarcinoma (pancreatic ductal adenocarcinoma [PDAC]) over 20 years in a large population of patients. METHODS: We identified 1404 consecutive patients (52% women; mean age, 67.5 years) with a diagnosis of branch-duct IPMN, from 1994 through 2017, at the University of Tokyo in Japan. Using a competing risk analysis, we estimated cumulative incidence of pancreatic carcinoma, overall and by carcinoma type. We used competing risks proportional hazards models to estimate subdistribution hazard ratios (SHRs) for incidences of carcinomas. To differentiate IPMN-derived and concomitant carcinomas, we collected genomic DNA from available paired samples of IPMNs and carcinomas and detected mutations in GNAS and KRAS by polymerase chain reaction and pyrosequencing. RESULTS: During 9231 personyears of follow-up, we identified 68 patients with pancreatic carcinomas (38 patients with IPMN-derived carcinomas and 30 patients with concomitant PDACs); the overall incidence rates were 3.3%, 6.6%, and 15.0% at 5, 10, and 15 years, respectively. Among 804 patients followed more than 5 years, overall cumulative incidence rates of pancreatic carcinoma were 3.5% at 10 years and 12.0% at 15 years from the initial diagnosis. The size of the IPMN and the diameter of the main pancreatic duct associated with incidence of IPMNderived carcinoma (SHR 1.85; 95% confidence interval 1.38-2.48 for a 10-mm increase in the IPMN size and SHR 1.56; 95% confidence interval 1.33-1.83 for a 1-mm increase in the main pancreatic duct diameter) but not with incidence of concomitant PDAC. CONCLUSIONS: In a large long-term study of patients with branch-duct IPMNs, we found the 5year incidence rate of pancreatic malignancy to be 3.3%, reaching 15.0% at 15 years after IPMN diagnosis. We observed heterogeneous risk factor profiles between IPMNderived and concomitant carcinomas.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2020

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“…Other guidelines were published by the American College of Gastroenterology (ACG) [35], the American Gastroenterological Association (AGA) [36], and the European Study Group on Cystic Tumors of the Pancreas [37] (Table 4). The criteria adopted by these latter guidelines have been examined in a few studies [38,39], but not as extensively as the ICG, which remain the standard reference all over the world. The standard radiological work-up proposed in the ICG includes computed tomography (CT), magnetic resonance (MR), and magnetic resonance cholangiopancreatography (MRCP), which are very sensitive in differentiating between benign and malignant lesions, but suffer from a suboptimal specificity [33,40,41].…”

Section: Discussionmentioning

confidence: 99%

The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Serafini

Sperti

Brazzale

et al. 2020

Cancers

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Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a heterogeneous group of tumors, increasingly diagnosed in clinical practice. An early differential diagnosis between malignant and benign lesions is crucial to patient management and the choice of surgery or observation. The therapeutic approach is currently based on a patient’s clinical, biochemical, and morphological characteristics. The latest published International Consensus Guidelines (ICG) make no mention of the role of metabolic assessments of IPMNs. The aim of this study was to review the current literature, examining the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in IPMN management. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 10 articles were analyzed in detail, focusing on the value of PET as opposed to other standard imaging criteria. Data were retrieved on 419 patients. The 18-FDG-PET proved more sensitive, specific, and accurate than the ICG criteria in detecting malignant IPMNs (reaching 80%, 95%, and 87% vs. 67%, 58%, and 63%, respectively). Metabolic assessments may be used as an additional tool for the appropriate management of patients with doubtful imaging findings.

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“…[18] Conversely, accumulating evidence suggests that patients with BD-IPMN may remain at high risk of developing pancreatic carcinoma after 5-year surveillance. [19][20][21] In a Japanese study involving 804 patients with BD-IPMNs followed for > 5 years, the overall cumulative incidence of pancreatic cancer was 3.5% at 10 years from initial diagnosis. [21] In a study at a US referral center, high-grade dysplasia and invasive carcinoma were observed in 20 (5.5%) and 16 (4.4%) patients, respectively, of 363 patients included at the time of 5 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Development of High-Risk Stigmata in Branch-Duct Intraductal Papillary Mucinous Neoplasms

Yamazaki

Tomoda

Kato

et al. 2020

Preprint

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Background: Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study aimed to identify the risk factors associated with the development of HRS during follow-up.Methods: We performed a retrospective analysis of 283 patients with BD-IPMN, treated at the Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for >1 year were included in the study. We performed radiological follow-up every 6 months and collected patients’ demographic data, cyst characteristics, and clinical outcomes. Cyst size was recorded at the initial and final imaging studies and growth rate was calculated. The primary outcome was to evaluate the risk factors for development of HRS in patients with BD-IPMN without HRS at the initial diagnosis.Results: Patients with BD-IPMN had a median follow-up of 53.3 months. Based on image analyses, a mean cysts size were initially 18.0 mm and their final size was 20.4 mm, and the mean annual cyst growth was 0.57 mm. Among them, 10 patients (3.5%) developed HRS after a median surveillance period of 55.8 months. Main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were, both, independent risk factors for the development of HRS (odds ratio, 14.2; 95% CI, 3.1-65.2, P = .0006, and odds ratio, 6.1; 95% CI 1.5-25.5, P = .014). Considering the number of worrisome features (WFs), the rate of HRS development was not a WF: 2.0% (4/199), a single WF: 1.6% (1/62), multiple WFs: 22.7% (5/22), and significantly higher in multiple WFs (95% CI: 4.0–57.1; p=.0003).Conclusions: MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity for surgical intervention.

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Validation of the American Gastroenterological Association guidelines on management of intraductal papillary mucinous neoplasms: more than 5 years of follow-up

Cited by 21 publications

References 21 publications

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Risk Factors for Development of High-Risk Stigmata in Branch-Duct Intraductal Papillary Mucinous Neoplasms

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