title: Morphologic changes in branch duct intraductal papillary mucinous neoplasms of the pancreas: a midterm follow-up study.
abstract: 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.
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Rautou
authors.forename: Phillippe
authors.initials: P
authors.lastname: Lévy
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
authors.forename: Anne
authors.initials: A
authors.lastname: Couvelard
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Hatem
authors.forename: Laurent
authors.initials: L
authors.lastname: Palazzo
authors.forename: Alain
authors.initials: A
authors.lastname: Aubert
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
authors.forename: Vinciane
authors.initials: V
authors.lastname: Rebours
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Pelletier
authors.forename: Frédérique
authors.initials: F
authors.lastname: Maire
authors.forename: Phillippe
authors.initials: P
authors.lastname: Ruszniewski
mesh_terms: 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