title: Intraductal papillary mucinous neoplasia (IPMN) of the pancreas: its diagnosis, treatment, and prognosis.
abstract: BACKGROUND
  The many varieties of cystic pancreatic tumor, and especially intraductal papillary mucinous neoplasia (IPMN), have attracted increased attention recently. Their incidence may be rising, and their histopathological evaluation and classification have become more precise than before.
  
  
  METHODS
  We discuss the current diagnostic evaluation of IPMN, along with treatment and prognostication, on the basis of the current international guideline as well as pertinent literature retrieved by a selective PubMed search.
  
  
  RESULTS
  The preoperative diagnostic evaluation of IPMN is often problematic. In particular, it may not be possible to differentiate main-duct disease from branch-duct disease (MD-IPMN vs. BD-IPMN) before surgery--a distinction with implications for prognosis and treatment, as MD-IPMN is more often malignant. An IPMN adenoma can develop into invasive pancreatic cancer. Because firm diagnostic criteria are still lacking, it is recommended that all MD-IPMN lesions and all large BD-IPMN lesions should be resected. Partial pancreatectomy with clean margins is the treatment of choice.
  
  
  CONCLUSIONS
  As IPMN seems to be a slow-growing precursor of pancreatic cancer, it is possible that its early detection and surgical treatment can lead to a cure. No conclusion about the efficacy of surveillance and follow-up programs can be drawn from the available evidence. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is needed to enable further improvements in diagnosis and treatment.
authors.affiliation: Chirurgische Klinik, Universitätsmedizin Mannheim, Med. Fakultät Mannheim, Mannheim, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Hans Detlev
authors.initials: HD
authors.lastname: Saeger
authors.forename: Marco
authors.initials: M
authors.lastname: Niedergethmann
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D018300:Papilloma, Intraductal / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D016896:Treatment Outcome