The long term risk of malignancy in patients with branch duct intraductal papillary mucinous neoplasms of the pancreas

Pancreatology. May-Jun 2012;12(3):198-202. doi: 10.1016/j.pan.2012.03.056. Epub 2012 Mar 20.

Abstract

In patients (pts) with branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMN), the risk of malignant progression is well described at short- and mid-term. Few data beyond 5 years are available.

Patients and methods: Prospective study in consecutive patients (pts) with BD-IPMN and follow-up (F/U) ≥60 months to assess long term risk of malignant progression. All computed tomographies and magnetic resonance cholangiopancreatographies performed every 1 or 2 years (depending on the maximum size of cyst) were read by the same radiologist. EUS was performed in case of occurrence of main pancreatic duct (MPD) dilation or mural nodule >5 mm. Size increase was considered significant if >5 mm. Size variation, criteria suggestive of malignancy, operative therapy and pathology were recorded.

Results: 53 pts were included (median age at diagnosis: 61 years, median F/U: 84 months (range: 60-132) including 5 F/U >120 months). Lesions were stable in 38 pts (72%). Size increased in 8 pts (15%) (median increase : 11 (5-33) mm) without mural nodule (MN). One of those was operated on (low-grade dysplasia). A MN appeared in 5 pts (9%). ≥5 mm in 2 pts (5 and 15 mm) who were operated on (intermediate-grade dysplasia in both). The 3 remaining pts (MN < 5 mm) were carefully followed-up. Invasive advanced carcinoma occurred in 2 pts, both after 84 months F/U. In one of these, no imaging changes were noted 12 months before diagnosis of malignancy.

Conclusion: In BD-IPMN, the risk of malignant evolution persists after 60 months F/U including invasive carcinomas. F/U imaging surveillance is still necessary beyond this delay in patients fit for potential surgery.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Pancreatic Ductal / diagnosis
  • Carcinoma, Pancreatic Ductal / pathology*
  • Cell Transformation, Neoplastic / pathology
  • Cholangiopancreatography, Magnetic Resonance
  • Disease Progression
  • Endosonography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasms, Cystic, Mucinous, and Serous / diagnosis
  • Neoplasms, Cystic, Mucinous, and Serous / pathology*
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / pathology*
  • Prospective Studies
  • Risk
  • Tomography, X-Ray Computed