Estimation of the prevalence of intraductal papillary mucinous neoplasm of the pancreas in the French population through patients waiting for liver transplantation

Abstract

Background and aims: Some studies have explored the prevalence of pancreatic cystic lesions (PCLs). Only one study based on magnetic resonance imaging (MRI) report examination focused specifically on intraductal papillary mucinous neoplasm (IPMN) in a European general population. The aim of this study was to evaluate the prevalence of IPMN in a population of patients who had MRI for a non-pancreatic disease. Methods: We conducted a retrospective, single-center study. All consecutive patients placed on the French liver transplant waiting list who had MRI for a non-pancreatic disease before liver transplantation between 2009 and 2013 were included. Only diagnoses consistent with IPMN were retained (cyst(s) clearly communicating with the main pancreatic duct). Results: Among 315 patients on the national waiting list, 212 patients had an MRI. PCLs with ductal communication were diagnosed in 14 patients (6.6%; six women, eight men, median age 62 years (45-70)). Liver disease was caused by a virus in seven cases, alcohol in three cases, other in four cases (multiple causes possible). Four patients had hepatocellular carcinoma. No patient had clinical or radiological sign of chronic pancreatitis. The median diameter of the largest cystic lesion was 14 mm (7-22). The number of PCLs was one (n ¼ 4), two (n ¼ 2), four (n ¼ 3), five (n ¼ 2), > 5 (n ¼ 3), respectively. There was no worrisome or main pancreatic duct involvement. Conclusions: Prevalence of pancreatic cystic lesions consistent with the diagnosis of IPMN was 6.6% in French patients waiting for liver transplantation. These results underscore that IPMN can be considered as a public health problem and justify a screening.

Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients

“…In a French study of LT waitlist patients, IPMN was identified in 6.6% (14/212 patients) using MRI. No worrisome features, pancreatic resections or pancreatic adenocarcinomas were observed[ 14 ]. In contrast, Lennon et al[ 15 ] followed 297 patients with side-branch IPMN and found high-risk features in up to 17%, potentially related to a higher proportion of patients undergoing EUS.…”

Progression of Unresected Intraductal Papillary Mucinous Neoplasms of the Pancreas to Cancer: A Systematic Review and Meta-analysis

“…Although the true prevalence is not known because many IPMNs are asymptomatic, several patient series comprising adults undergoing abdominal computed tomography or magnetic resonance imaging for non-pancreatic causes reported prevalence ranging from 2.6% to 13.5%. [5][6][7] A recent large surgical series also reported that IPMN accounts for the largest fraction of cystic pancreatic neoplasms. 8 Therefore, it is critical to understand and establish a standard regarding how to best manage this disease.…”

Next generation sequencing of the cellular and liquid fraction of pancreatic cyst fluid supports discrimination of IPMN from pseudocysts and reveals cases with multiple mutated driver clones: First findings from the prospective ZYSTEUS biomarker study

“…4 Pathologists presume that most of the detected pancreatic cysts are IPMN 5,6 and radiologists usually interpret all pancreatic cysts as IPMN when they are connected to the main duct or the branch duct of the pancreas. 7 Cyst size alone is not a sufficient parameter to indicate surgery given its poor predictive value for HGD and invasive cancer. 8 Endoscopic ultrasound (EUS) with fine needle aspiration (biopsy)…”