Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Abstract

Summary Background Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long‐term surveillance is low‐yield for most individuals. Aim To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high‐risk stigmata. Methods We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side‐branch IPMN, without worrisome features or high‐risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high‐risk stigmata during follow‐up. We created a multivariable prediction model using Cox‐proportional logistic regression analysis and performed an internal‐external validation. Results 875 patients were included. After a mean follow‐up of 50 months (range 12‐157), 116 (13%) patients developed worrisome features or high‐risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09‐1.15), cyst multifocality (HR 1.49, 95% CI 1.01‐2.18), ever having smoked (HR 1.40, 95% CI 0.95‐2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21‐3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91‐1.97). After validation, the model had good discriminative ability (C‐statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion In presumed side branch IPMNs without worrisome features or high‐risk stigmata at baseline, the Dutch‐American Risk stratification Tool (DART‐1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high‐risk stigmata.

Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms

“…11,12 Also, information on possible patient-related factors associated with progression risk is limited. 9,10 In addition to the limited knowledge of cyst and patient features, there are few available data on the role of genetic variants in this context. Because it has been reported that non-type O blood is associated with an increased risk of PDAC, 13,14 we hypothesized that this variant might also be associated with the risk of progression of BD-IPMN.…”

Endoscopic Management and Follow-Up of Intraductal Papillary Mucinous Neoplasia (IPMN)

“…Duration and intensity of surveillance differ between guidelines and are summarized in Table 4. Recent development of the Dutch American Risk Tool for IPMN (DART-I) allows more precise risk prediction for conversion to worrisome or high-risk features in BD-IPMN and may allow more conservativeor discontinuedsurveillance in low-risk IPMN [129]. Last years, there has been an increasing interest in artificial intelligence (AI)based diagnosis of IPMN and PCN in general.…”

Editorial: when, who and how—the ever‐evolving management of pancreatic cystic lesions. Authors’ reply

“…The authors' declarations of personal and financial interests are unchanged from those in the original article …”

“…We were pleased to read the editorial comments by Drs. Yang and Forsmark regarding our study describing the development of a stratification tool to identify low‐risk side branch intraductal papillary mucinous neoplasms (SB‐IPMN) . We thank them for commending us on our efforts, and for recognising the potential importance of developing a negative prediction tool to limit unnecessary procedures and to reduce the burden of surveillance on patients and the healthcare system.…”