The Natural History of Main Duct–Involved, Mixed-Type Intraductal Papillary Mucinous Neoplasm

Abstract

Primary surveillance of mixed-type IPMN may be a reasonable strategy in select patients. Diffuse MPD dilation, serum CA19-9, serum alkaline phosphatase, and absence of extrapancreatic cysts predict patients likely to progress during primary surveillance.

MIB-1 labeling index, Ki-67, is an indicator of invasive intraductal papillary mucinous neoplasm

“…Therefore, the present study classified the patients into two groups: Non-invasive, including IPMNs with carcinoma in situ component, and invasive IPMN. By contrast, the existence of a mural nodule has been reported to be a predictive factor for invasive IPMN (6,7).…”

“…The latest International Consensus Guidelines, however, described worrisome features of malignancy, including a cyst >3 cm, thickened and enhanced cyst walls, main pancreatic duct size 5-9 mm, non-enhancing mural nodule, abrupt change in caliber of duct with distal pancreatic atrophy and lymphadenopathy (4). No criterion has been proven accurate in predicting an invasive progression in main duct IPMN (6). Several previous studies described predictors of malignancy of main duct IPMN: Older age, more frequent incidence of jaundice and/or worsening of diabetes, >15 mm dilatation of the main pancreatic duct and a mural nodule (5,7).…”

Invasive, mixed-type intraductal papillary mucinous neoplasm: Superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm

“…16 There is no consensus on predictors of malignancy in MT-IPMN (especially diameter of main pancreatic duct, size of index cyst, mural nodule, or presence of symptoms). 5,[17][18][19][20] The authors of a recent surveillance study found that predictors of progression toward invasive MT-IPMN included an increased serum CA19-9 or serum alkaline phosphatase, diffuse main pancreatic duct dilation, and the absence of nonpancreatic intraabdominal cysts. 17 They concluded that primary surveillance may be an option, but only in a select and older population where the mortality/ morbidity associated with pancreatectomy may outweigh the risk of malignant transformation.…”

Cystic Neoplasm of the Pancreas

“…In partial contrast with these recommendations, a recent study suggested that primary surveillance seems to be feasible in selected patients affected by mixed-type IPMN. In particular, the progression to an invasive carcinoma was described in only 13 % of cases after 4-5 years of follow-up [26,27]. This evidence pictures how, even if extremely valuable in the clinical practice, the guidelines are not comprehensive and need further validation and modification through large, prospective, cohort studies.…”