Natural history of low-risk branch-duct intraductal papillary mucinous neoplasms and indeterminate pancreatic cysts: Implications on surveillance intervals by cyst size.
Hwee-Leong Tan, Jonathan Hee, Jania Wu, Grace R S Lim, Damien M Y Tan, Albert S Low, Choon-Hua Thng, Ye-Xin Koh, Brian K P Goh
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引用次数: 0
Abstract
Background: The optimal surveillance strategy for low-risk branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) remains unclear. We aim to evaluate the natural history of low-risk BD-IPMN/indeterminate pancreatic cysts to determine optimal surveillance intervals.
Methods: We conducted a retrospective cohort study of patients with radiologically-diagnosed low-risk BD-IPMN/indeterminate pancreatic cysts from 1998 to 2021 at a tertiary referral center. Low-risk BD-IPMN, worrisome features (WF) and high-risk stigmata (HRS) were defined as per existing guidelines. Patients were grouped into three categories based on cyst size at diagnosis: <10 mm, 10-19 mm and 20-29 mm. The size distribution and cumulative incidence of WF and HRS development were charted annually for the first five years.
Results: We studied 1668 patients, with 794 (47.6 %), 652 (39.1 %) and 222 (13.3 %) with cysts <10 mm, 10-19 mm and 20-29 mm at baseline respectively. Overall WF and HRS development was seen in 11.7 % and 1.4 % of patients respectively, with higher proportion of WF (6.8 vs 9.8 vs 34.7 %, p < 0.001) and HRS (0.9 vs 1.4 vs 3.6 %, p = 0.011) development with increasing baseline size category. Cysts <10 mm had 94.3 % < 30 mm at five years, 2.0 % WF at one year and a single case of HRS at two years. Cysts 10-19 mm had 94.7 % < 30 mm at five years, 2.2 % WF at one year and the first incident case of HRS at one year. Cysts 20-29 mm had 63.8 % < 30 mm at five years, 9.5 % WF and 1.1 % (4 cases) HRS by one year.
Conclusion: Baseline cyst size can be used to guide surveillance intervals for low-risk BD-IPMN/indeterminate pancreatic cysts.
期刊介绍：
Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.
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