Morphologic changes in branch duct intraductal papillary mucinous neoplasms of the pancreas: a midterm follow-up study.
OBJECTIVE
Because there is a low risk of malignancy for intraductal papillary and mucinous neoplasms of the pancreas (IPMNs) confined to branch ducts (BD), patient follow-up evaluation without surgery is possible. The aim of this study was to assess time-related morphologic changes and risk of progress to malignancy in patients with BD IPMN. A prospective design was used in an academic tertiary referral center.


METHODS
All consecutive patients seen from 1999 to 2005 with highly suspected IPMNs confined to BD without criteria suggesting a malignant development (mural nodule, cyst wall thickness >2 mm, BD diameter >30 mm, or main pancreatic duct involvement) were followed up prospectively using computerized tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography.


RESULTS
A total of 121 patients (median age, 63 y) were included. After a median follow-up period of 33 months, no morphologic changes had occurred in 88 patients. The size of the cyst increased in 30 of the 33 remaining patients, and 12 developed criteria suggesting a malignant development. Surgery, performed in 8 of 12 patients, found 4 IPMN-adenomas, 1 borderline-IPMN, and 4 IPMN carcinoma in situ. The 4 remaining patients did not undergo surgery because of severe comorbid conditions in 2, change in reference hospital in 1, and a mural nodule considered being sequelae of previous fine-needle aspiration in 1 patient. The only factor associated with signs suggesting malignant development was an increase in cyst size to more than 5 mm during the follow-up evaluation.


CONCLUSIONS
In patients with IPMNs confined to BD, morphologic changes are rare events, justifying a nonsurgical approach. Careful follow-up evaluation remains necessary, particularly in patients with an increase in BD size.
Rautou
Pierre-Emmanuel
PE
Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, France.
Lévy
Phillippe
P
Vullierme
Marie-Pierre
MP
O'Toole
Dermot
D
Couvelard
Anne
A
Cazals-Hatem
Dominique
D
Palazzo
Laurent
L
Aubert
Alain
A
Sauvanet
Alain
A
Hammel
Pascal
P
Hentic
Olivia
O
Rebours
Vinciane
V
Pelletier
Anne-Laure
AL
Maire
Frédérique
F
Ruszniewski
Phillippe
P
D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D049448:Cholangiopancreatography, Magnetic Resonance; D003135:Common Bile Duct / Q000473:pathology; D003560:Cysts / Q000473:pathology; D018450:Disease Progression; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011446:Prospective Studies; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome