Development of Pancreatic Cancers During Long-Term Follow-Up of Side-Branch Intraductal Papillary Mucinous Neoplasms

Endoscopy. 2010 Dec;42(12):1077-84. doi: 10.1055/s-0030-1255971. Epub 2010 Nov 30.

Abstract

Background and study aims: Side-branch intraductal papillary mucinous neoplasms (SB-IPMNs), and associated synchronous and metachronous pancreatic cancers are increasingly detected as imaging modalities become more sensitive. We investigated the natural history of SB-IPMN, and the incidence and characteristics of pancreatic cancers among patients undergoing long-term follow-up.

Patients and methods: We reviewed the clinical, imaging, and pathological features in 103 patients, diagnosed at the Aichi Cancer Center between September 1988 and September 2006 as having SB-IPMN, and conservatively followed up for ≥ 2 years (median 59 months) based on an endoscopic ultrasonography (EUS) database.

Results: 74 (71.8 %) patients had nonprogressive lesions. Overall, six patients (5.8 %) developed pancreatic cancers during follow-up, with intraductal papillary mucinous (IPM) carcinoma in four, and ductal carcinoma of pancreas that was not IPMN in two patients. Of the six pancreatic cancers, five were diagnosed at a resectable stage. The 5-year and 10-year actuarial rates of development of pancreatic cancer were 2.4 % and 20.0 %, respectively. Although, at the last follow-up, cyst size, main pancreatic duct (MPD) diameter, mural nodule size, and frequency of metachronous and/or synchronous cancers of other organs were significantly higher in patients who developed IPM carcinoma, resected SB-IPMNs without mural nodules and dilated MPDs had no IPM carcinomas.

Conclusions: The frequency of pancreatic cancers is high on long-term follow-up of SB-IPMN. Although conservative management is appropriate for selected patients, regular and long-term imaging, especially by EUS is essential, even if SB-IPMN remains unchanged for 2 years. Presence of mural nodule and dilated MPD seem to be more appropriate indicators for resection than cyst size alone for SB-IPMNs.

MeSH terms

  • Adenocarcinoma, Mucinous / diagnostic imaging
  • Adenocarcinoma, Mucinous / pathology*
  • Adenocarcinoma, Papillary / diagnostic imaging
  • Adenocarcinoma, Papillary / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / epidemiology
  • Carcinoma, Pancreatic Ductal / pathology*
  • Carcinoma, Papillary / diagnostic imaging
  • Carcinoma, Papillary / epidemiology
  • Carcinoma, Papillary / pathology*
  • Disease Progression
  • Endosonography
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / diagnostic imaging
  • Neoplasms, Multiple Primary / epidemiology
  • Neoplasms, Multiple Primary / pathology*
  • Pancreatic Ducts / diagnostic imaging
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / epidemiology
  • Pancreatic Neoplasms / pathology*
  • Prognosis
  • Statistics, Nonparametric
  • Time Factors