From the AGA Journals

Branch duct intraductal papillar mucinous neoplasms confer increased malignancy risk


Key clinical point: Branch duct intraductal papillary mucinous neoplasms conferred a markedly increased risk of malignancy even when they lacked worrisome features at baseline.

Major finding: At 5 years, the standardized incidence ratio for malignancy was 18.8 compared with the general population.

Data source: A retrospective study of 577 patients with suspected branch duct intraductal papillary mucinous neoplasms.

Disclosures: The investigators did not disclose external funding sources. They reported having no relevant conflicts of interest.

The appropriate surveillance strategy for branch duct IPMNs is a point of debate, and numerous guidelines have offered recommendations for managing these potentially malignant neoplasms. Among the contested topics is the appropriateness of ceasing imaging surveillance of lesions that are stable over years. In 2015, an American Gastroenterological Association guideline made a conditional recommendation for cessation of imaging surveillance of pancreatic cysts that have remained stable after 5 years, noting that only very low-quality evidence was available. Given the paucity of data on this topic, this recommendation has been debated. 

Dr. Pergolini and colleagues shed new light on this question with this retrospective review. Their study demonstrates that a dramatically increased risk of developing pancreatic malignancy persists even when a branch duct IPMN demonstrates no worrisome features or growth after 5 years of imaging surveillance. In fact, in their cohort, the risk of malignancy not only persisted among patients with branch duct IPMNs compared to population-based controls, but in fact, the risk was even greater after 5 years of follow-up. The risk persisted even after 10 years of follow-up. This study lends credibility to the opinion that branch duct type IPMNs should undergo ongoing surveillance even after 5 years of stability on imaging. Furthermore, it invites further study on smaller (less than 1.5 cm) branch duct IPMNs that remain stable over 5 years, as they appear to be very low risk and may represent a category of IPMNs that do not require indefinite surveillance.

Anthony Gamboa, MD, is assistant professor of medicine, program director of advanced endoscopy fellowship, division of gastroenterology, hepatology and nutrition, Vanderbilt University, Nashville, Tenn. He has no conflicts of interest.




Patients with branch duct intraductal papillary mucinous neoplasms were about 19 times more likely to develop malignancies over 5 years compared with the general population, although they lacked worrisome features of malignancy at baseline.

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