Liver, Pancreas and Biliary TractRisk factors for malignant progression of intraductal papillary mucinous neoplasms
Introduction
Since its first consideration as an independent entity in 1996 [1], intraductal papillary mucinous neoplasms (IPMN) of the pancreas have been diagnosed with increasing frequency [2]. Detection and resection of IPMN offer a unique opportunity to cure and prevent adenocarcinoma of the pancreas, an otherwise highly lethal disease. The main clinical concern related to IPMN is its wide-ranging potential for malignancy from low-risk indolent lesions to those with high incidence of malignant degeneration. It is well-established that this malignant progression varies based on the morphological subtypes [3], [4], [5], [6]. The current methods of predicting malignant potential are limited to clinical, morphological, and cyst fluid cytology and biomarker data.
To address these limitations, the aim of the present study is to identify and define the risk factors for malignancy progression in IPMN.
Section snippets
Materials and methods
The ethics committee at each of the participating centres approved collection of the registry data.
Results
A total of 1167 patients with a clinical suspicion of an IPMN were included from October 1997 until November 2013. This included 972 patients from Mayo Clinic, 95 from San Raffaele Hospital, 87 from San Giovanni Battista Hospital, and 13 from Imola Hospital.
From this cohort, 41 patients were finally excluded from the analysis due to a pathological diagnosis different from IPMN after surgical resection, leading to a final study sample of 1126 patients (Fig. 1). Overall, the median age was 70.6
Discussion
Our study suggests that imaging features, such as main duct involvement, mural nodules, and specific pancreatic symptoms such as steatorrhea or jaundice, are associated with malignancy in IPMN. It further adds that higher BMI and any tobacco exposure are significant risk factors.
The current IPMN guidelines [7], [8], [9], [10] have provided a valuable framework for management, but were largely based on limited clinical data and expert opinion. Despite the recent progress in the diagnostic
Conflict of interest
MBW receives grant funding from Olympus, Boston Scientific, and Cosmo Pharmaceuticals. None of the other authors have conflicts of interest to disclose.
Funding
This project was funded by The Joyce E. Baker Foundation for research at Mayo Clinic in Florida.
References (30)
- et al.
Morphologic changes in branch duct intraductal papillary mucinous neoplasms of the pancreas: a midterm follow-up study
Clinical Gastroenterology and Hepatology
(2008) - et al.
European experts consensus statement on cystic tumours of the pancreas
Digestive and Liver Disease
(2013) - et al.
International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas
Pancreatology
(2006) - et al.
International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas
Pancreatology
(2012) - et al.
Pancreatic resections for cystic neoplasms: from the surgeon's presumption to the pathologist's reality
Surgery
(2012) - et al.
Incidental pancreatic cysts: do we really know what we are watching?
Pancreatology
(2010) - et al.
Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis
Clinical Gastroenterology and Hepatology
(2013) - et al.
Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis
Annals of Surgery
(2014) - et al.
Utility of the Sendai consensus guidelines for branch-duct intraductal papillary mucinous neoplasms: a systematic review
Journal of Gastrointestinal Surgery
(2014) - et al.
Endoscopic ultrasonographic findings predict the risk of carcinoma in branch duct intraductal papillary mucinous neoplasms of the pancreas
Pancreatology
(2012)
Histological typing of tumours of the exocrine pancreas
Intraductal papillary mucinous neoplasms of the pancreas
Gastroenterology
Precursors to invasive pancreatic cancer
Advances in Anatomic Pathology
Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms
Endoscopy
Malignant transformation of branch duct-type intraductal papillary mucinous neoplasms of the pancreas based on contrast-enhanced endoscopic ultrasonography morphological changes: focus on malignant transformation of intraductal papillary mucinous neoplasm itself
Pancreas
Cited by (12)
Prevalence and progression of intraductal papillary mucinous neoplasms of the pancreas in solid organ transplant recipients: A systematic review
2023, American Journal of TransplantationDiabetes mellitus and the risk of progression or malignancy of pancreatic cystic neoplasms in patients undergoing surveillance: A systematic review and meta-analysis
2022, PancreatologyCitation Excerpt :Obesity was associated with high risk of progression in multivariate analysis in 2 studies [18,21]. In a study by Moris et al. [13], mean BMI of cohorts who had malignant transformation was compared to controls, the risk of malignancy with higher BMI was found to be significant (OR = 1.1, CI 1–1.1, P = 0.01). Multivariate values of risk association with obesity were reported as either HR and OR which cannot be treated as equivalent.
Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas
2018, Surgery (United States)Citation Excerpt :According to the results of the literature review, the presence of MN has 62.9% sensitivity, 74.5% specificity, 62.2% positive predictive value, and 75.1% negative predictive value for the presence of HGD/invasive cancer at final pathologic evaluation (Supplementary Fig S2). Several studies did not differentiate HGD from invasive cancer, considering all these IPMNs as “malignant.”12-20 Thirty-nine studies reported data on MN size, 17 of which proposed a dimensional cutoff to segregate groups according to their risk of malignant progression (Supplementary Table S1).
Diabetes mellitus in intraductal papillary mucinous neoplasm of the pancreas is associated with high-grade dysplasia and invasive carcinoma
2017, PancreatologyCitation Excerpt :Diabetes mellitus (DM) is a frequent finding in patients with pancreatic ductal adenocarcinoma (PDAC) and a wealth of epidemiological evidence indicates that new-onset DM is strongly associated with a PDAC diagnosis [3–10]. Whether DM is associated with malignant progression of IPMN is not well established, and only a few studies have reported associations between DM and degree of dysplasia in IPMN with conflicting results [11–18]. Factors associated with increased risk of developing PDAC may or may not exert the same influence on the malignant progression of IPMN, since genomic and morphologic analyses of invasive carcinomas arising from IPMN have revealed critical distinguishing features from conventional PDAC [19–22].
A model for predicting degree of malignancy in patients with intraductal papillary mucinous neoplasm
2023, Frontiers in Oncology