PDF herunterladen
Digestive Disease Interventions
DOI: 10.1055/s-0045-1807271
Review Article

Updates in Intraductal Papillary Mucinous Neoplasm Clinical Risk Stratification

Katherine Bingmer 
1   Department of Surgical Oncology, Johns Hopkins University, Baltimore, Maryland
,
Richard A. Burkhart
1   Department of Surgical Oncology, Johns Hopkins University, Baltimore, Maryland
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) comprise a majority of pancreatic cystic neoplasms and are precursors of pancreatic ductal adenocarcinoma. Ideal management involves surgical resection of IPMN that harbors high-grade dysplasia prior to the development of invasive disease in appropriate patients. Additionally, identification of low-risk IPMN allows for avoidance of unnecessary morbidity associated with surgical resection. Malignant potential varies widely and it can be difficult to predict which IPMNs are at highest risk. A number of studies and guidelines have been published to assist clinicians in stratification of IPMNs into those that should be considered for surgical resection, those which warrant close surveillance, and those in whom you may safely consider cessation of surveillance. This review will summarize recent literature that can help guide the clinical management of IPMN based on malignant potential.

Keywords

intraductal papillary mucinous neoplasm - pancreatic ductal adenocarcinoma - guidelines


Publikationsverlauf

Eingereicht: 10. Oktober 2024

Angenommen: 13. März 2025

Artikel online veröffentlicht:
28. April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Werner J, Fritz S, Büchler MW. Intraductal papillary mucinous neoplasms of the pancreas – a surgical disease. Nat Rev Gastroenterol Hepatol 2012; 9 (05) 253-259
    CrossrefPubMedSuche in Google Scholar
  • 2 Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023; 73 (01) 17-48
    CrossrefPubMedSuche in Google Scholar
  • 3 Lidsky ME, Sun Z, Nussbaum DP, Adam MA, Speicher PJ, Blazer III DG. Going the extra mile: improved survival for pancreatic cancer patients traveling to high-volume centers. Ann Surg 2017; 266 (02) 333-338
    PubMedSuche in Google Scholar
  • 4 Canto MI, Kerdsirichairat T, Yeo CJ. et al. Surgical outcomes after pancreatic resection of screening-detected lesions in individuals at high risk for developing pancreatic cancer. J Gastrointest Surg 2020; 24 (05) 1101-1110
    PubMedSuche in Google Scholar
  • 5 Tanaka M, Chari S, Adsay V. et al; International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6 (1-2): 17-32
    CrossrefPubMedSuche in Google Scholar
  • 6 Tanaka M, Fernández-del Castillo C, Adsay V. et al; International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12 (03) 183-197
    CrossrefPubMedSuche in Google Scholar
  • 7 Tanaka M, Fernández-Del Castillo C, Kamisawa T. et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17 (05) 738-753
    PubMedSuche in Google Scholar
  • 8 Vege SS, Ziring B, Jain R, Moayyedi P. Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148 (04) 819-822 , e12–e13
    CrossrefPubMedSuche in Google Scholar
  • 9 European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67 (05) 789-804
    PubMedSuche in Google Scholar
  • 10 Hruban RH, Takaori K, Klimstra DS. et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol 2004; 28 (08) 977-987
    CrossrefPubMedSuche in Google Scholar
  • 11 Roch AM, Schmidt CM. Management of mixed-type intraductal papillary mucinous neoplasm. Adv Surg 2016; 50 (01) 1-15
    PubMedSuche in Google Scholar
  • 12 Nagtegaal ID, Odze RD, Klimstra D. et al; WHO Classification of Tumours Editorial Board. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76 (02) 182-188
    CrossrefPubMedSuche in Google Scholar
  • 13 Adsay V, Mino-Kenudson M, Furukawa T. et al; Members of Verona Consensus Meeting, 2013. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of Verona consensus meeting. Ann Surg 2016; 263 (01) 162-177
    CrossrefPubMedSuche in Google Scholar
  • 14 Ohtsuka T, Fernandez-Del Castillo C, Furukawa T. et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024; 24 (02) 255-270
    CrossrefPubMedSuche in Google Scholar
  • 15 Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010; 105 (09) 2079-2084
    CrossrefPubMedSuche in Google Scholar
  • 16 Sainani NI, Saokar A, Deshpande V, Fernández-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 2009; 193 (03) 722-731
    CrossrefPubMedSuche in Google Scholar
  • 17 Waters JA, Schmidt CM, Pinchot JW. et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 2008; 12 (01) 101-109
    CrossrefPubMedSuche in Google Scholar
  • 18 Hecht EM, Khatri G, Morgan D. et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: recommendations for Standardized Imaging and Reporting from the Society of Abdominal Radiology IPMN disease focused panel. Abdom Radiol (NY) 2021; 46 (04) 1586-1606
    CrossrefPubMedSuche in Google Scholar
  • 19 Harima H, Kaino S, Shinoda S, Kawano M, Suenaga S, Sakaida I. Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2015; 21 (20) 6252-6260
    PubMedSuche in Google Scholar
  • 20 Han Y, Lee H, Kang JS. et al. Progression of pancreatic branch duct intraductal papillary mucinous neoplasm associates with cyst size. Gastroenterology 2018; 154 (03) 576-584
    PubMedSuche in Google Scholar
  • 21 Akahoshi K, Ono H, Akasu M. et al. Rapid growth speed of cysts can predict malignant intraductal mucinous papillary neoplasms. J Surg Res 2018; 231: 195-200
    CrossrefPubMedSuche in Google Scholar
  • 22 Kolb JM, Argiriadi P, Lee K. et al. Higher growth rate of branch duct intraductal papillary mucinous neoplasms associates with worrisome features. Clin Gastroenterol Hepatol 2018; 16 (09) 1481-1487
    CrossrefPubMedSuche in Google Scholar
  • 23 Crippa S, Fernández-Del Castillo C, Salvia R. et al. Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol 2010; 8 (02) 213-219
    PubMedSuche in Google Scholar
  • 24 Jung HS, Han Y, Kang JS. et al. Prediction of malignancy in main duct or mixed-type intraductal papillary mucinous neoplasms of the pancreas. J Hepatobiliary Pancreat Sci 2022; 29 (09) 1014-1024
    PubMedSuche in Google Scholar
  • 25 Marchegiani G, Andrianello S, Morbin G. et al. Importance of main pancreatic duct dilatation in IPMN undergoing surveillance. Br J Surg 2018; 105 (13) 1825-1834
    PubMedSuche in Google Scholar
  • 26 Zhou H, Li X, Wang Y. et al. Threshold of main pancreatic duct for malignancy in intraductal papillary mucinous neoplasm at head-neck and body-tail. BMC Gastroenterol 2022; 22 (01) 473
    PubMedSuche in Google Scholar
  • 27 Attiyeh MA, Fernández-Del Castillo C, Al Efishat M. et al. Development and validation of a multi-institutional preoperative nomogram for predicting grade of dysplasia in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: a report from the Pancreatic Surgery Consortium. Ann Surg 2018; 267 (01) 157-163
    CrossrefPubMedSuche in Google Scholar
  • 28 Iwaya H, Hijioka S, Mizuno N. et al. Usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched-duct and mixed-type intraductal papillary mucinous neoplasm of the pancreas. Dig Endosc 2019; 31 (06) 672-681
    PubMedSuche in Google Scholar
  • 29 Kazami Y, Arita J, Nishioka Y. et al. Preoperative predictive features of invasive carcinoma among intraductal papillary mucinous neoplasm of the pancreas. Pancreas 2022; 51 (06) 642-648
    PubMedSuche in Google Scholar
  • 30 Salvia R, Fernández-del Castillo C, Bassi C. et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004; 239 (05) 678-685 , discussion 685–687
    CrossrefPubMedSuche in Google Scholar
  • 31 Venkatesh PGK, Navaneethan U, Vege SS. Intraductal papillary mucinous neoplasm and acute pancreatitis. J Clin Gastroenterol 2011; 45 (09) 755-758
    PubMedSuche in Google Scholar
  • 32 Morales-Oyarvide V, Mino-Kenudson M, Ferrone CR. et al. Diabetes mellitus in intraductal papillary mucinous neoplasm of the pancreas is associated with high-grade dysplasia and invasive carcinoma. Pancreatology 2017; 17 (06) 920-926
    PubMedSuche in Google Scholar
  • 33 Capurso G, Boccia S, Salvia R. et al; Italian Association for Study of Pancreas (AISP), Intraductal Papillary Mucinous Neoplasm (IPMN) Study Group. Risk factors for intraductal papillary mucinous neoplasm (IPMN) of the pancreas: a multicentre case-control study. Am J Gastroenterol 2013; 108 (06) 1003-1009
    PubMedSuche in Google Scholar
  • 34 Fritz S, Hackert T, Hinz U, Hartwig W, Büchler MW, Werner J. Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas. Br J Surg 2011; 98 (01) 104-110
    PubMedSuche in Google Scholar
  • 35 Wang W, Zhang L, Chen L. et al. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 for prediction of malignancy and invasiveness in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Biomed Rep 2015; 3 (01) 43-50
    PubMedSuche in Google Scholar
  • 36 Felix K, Honda K, Nagashima K. et al. Noninvasive risk stratification of intraductal papillary mucinous neoplasia with malignant potential by serum apolipoprotein-A2-isoforms. Int J Cancer 2022; 150 (05) 881-894
    PubMedSuche in Google Scholar
  • 37 Hata T, Mizuma M, Motoi F. et al. GNAS mutation detection in circulating cell-free DNA is a specific predictor for intraductal papillary mucinous neoplasms of the pancreas, especially for intestinal subtype. Sci Rep 2020; 10 (01) 17761
    PubMedSuche in Google Scholar
  • 38 Wood LD, Adsay NV, Basturk O. et al. Systematic review of challenging issues in pathology of intraductal papillary mucinous neoplasms. Pancreatology 2023; 23 (07) 878-891
    PubMedSuche in Google Scholar
  • 39 Pflüger MJ, Jamouss KT, Afghani E. et al. Predictive ability of pancreatic cyst fluid biomarkers: a systematic review and meta-analysis. Pancreatology 2023; 23 (07) 868-877
    CrossrefPubMedSuche in Google Scholar