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Medline ® Abstract for Reference 63

of 'Intraductal papillary mucinous neoplasm of the pancreas (IPMN): Pathophysiology and clinical manifestations'

Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms.
Kang MJ, Jang JY, Kim SJ, Lee KB, Ryu JK, Kim YT, Yoon YB, Kim SW
Clin Gastroenterol Hepatol. 2011;9(1):87. Epub 2010 Sep 17.
BACKGROUND&AIMS: Little information is available about the clinico-pathologic characteristics of pancreatic branch duct intraductal papillary mucinous neoplasm (Br-intraductal papillary mucinous neoplasm [IPMN]) because of difficulties in diagnosis based on radiologic and tissue information. We investigated the natural history of Br-IPMN using imaging and surgical pathology data from patients.
METHODS: Data were collected from patients admitted to a single tertiary referral institution from January 2000 to March 2009 (median follow up of 27.9 months); 201 patients were diagnosed with Br-IPMN with an initial cyst less than 30 mm without main pancreatic duct dilatation or mural nodules. The patients were followed for more than 3 months and examined by computed tomography (CT) at least twice.
RESULTS: The mean size of the patients' initial cysts was 14.7 mm; the mean cyst growth rate was 1.1 mm/year. Thirty-five patients received surgery during follow up and 8 were confirmed to have malignant cysts. The malignant cysts were greater in final size than nonmalignant cysts (24.3 mm vs 16.9 mm; P = .003); they also grew by a greater percentage (69.8% vs 19.4%; P = .046) and at a greater rate (4.1 mm vs 1.0 mm/year; P = .001). The actuarial 5-year risk of malignancy was 41.6% in the group that received surgery and 10.9% for all patients. Cysts that grew more than 2 mm/year had a higher risk of malignancy (5-year risk = 45.5% vs 1.8%; P<.001).
CONCLUSIONS: In combination with cyst size and the presence of mural nodules, cyst growth rate could be used to predict malignancy in patients with Br-IPMN.
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.