Cited by 285Pancreatic and Hepatic Oncology ResearchSalivary Gland Tumors Diagnosis and TreatmentNeuroendocrine Tumor Research Advances

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Branch Duct Intraductal Papillary Mucinous Neoplasms: Does Cyst Size Change the Tip of the Scale? A Critical Analysis of the Revised International Consensus Guidelines in a Large Single-Institutional Series

Sahora, Klaus, Mino-Kenudson, Mari, Brugge, William, Thayer, Sarah P., Ferrone, Cristina R., Sahani, Dushyant, Pitman, Martha B., Warshaw, Andrew L., Lillemoe, Keith D., Fernandez-del Castillo, Carlos F.·2013·Annals of Surgery

DOI 10.1097/sla.0b013e3182a18f48

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Abstract

OBJECTIVE: The aim of this study was to critically analyze the safety of the revised guidelines, with focus on cyst size and worrisome features in the management of BD-IPMN. BACKGROUND: The Sendai guidelines for management of branch duct (BD) intraductal papillary mucinous neoplasm (IPMN) espouse safety of observation of asymptomatic cysts smaller than 3 cm without nodules (Sendai negative). Revised international consensus guidelines published in 2012 suggest a still more conservative approach, even for lesions of 3 cm or larger. By contrast, 2 recent studies have challenged the safety of both guidelines, describing invasive carcinoma or carcinoma in situ in 67% of BD-IPMN smaller than 3 cm and in 25% of "Sendai-negative" BD-IPMN. METHODS AND RESULTS: Review of a prospective database identified 563 patients with BD-IPMN. A total of 240 patients underwent surgical resection (152 at the time of diagnosis and 88 after being initially followed); the remaining 323 have been managed by observation with median follow-up of 60 months. No patient developed unresectable BD-IPMN carcinoma during follow-up. Invasive cancer arising in BD-IPMN was found in 23 patients of the entire cohort (4%), and an additional 21 patients (3.7%) had or developed concurrent pancreatic ductal adenocarcinoma. According to the revised guidelines, 76% of resected BD-IPMN with carcinoma in situ and 95% of resected BD-IPMN with invasive cancer had high-risk stigmata or worrisome features. The risk of high-grade dysplasia in nonworrisome lesions smaller than 3 cm was 6.5%, but when the threshold was raised to greater than 3 cm, it was 8.8%, and 1 case of invasive carcinoma was found. CONCLUSIONS: Expectant management of BD-IPMN following the old guidelines is safe, whereas caution is advised for larger lesions, even in the absence of worrisome features.

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Authors: Sahora, K., Mino-Kenudson, M., Brugge, W., Thayer, S. P., Ferrone, C. R., Sahani, D., Pitman, M. B., Warshaw, A. L., Lillemoe, K. D., & Fernandez-del Castillo, C. F.
Affiliations: Harvard University (US)
Corresponding author: Sahora, Klaus
Thayer, Sarah P.
Ferrone, Cristina R.
Warshaw, Andrew L.
Lillemoe, Keith D.
ORCID: Sahora, Klaus
Mino-Kenudson, Mari
Brugge, William
Thayer, Sarah P.
Ferrone, Cristina R.
Warshaw, Andrew L.
Lillemoe, Keith D.
Venue: Annals of Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-09
Volume: 258
Issue: 3
Pages: 466-475
ISSN: 0003-4932 (ISSN-L)
DOI: 10.1097/sla.0b013e3182a18f48
OpenAlex: W1979727565
Cited by: 285
References: 18
Citations by year: 2026: 12 · 2025: 10 · 2024: 11 · 2023: 23 · 2022: 8 · 2021: 12 · 2020: 26 · 2019: 14 · 2018: 29 · 2017: 39 · 2016: 38 · 2015: 37 · 2014: 26
FWCI: 18.04
Type: journal article
Language: en
Open access: closed
Locations: Annals of Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
Health Sciences › Medicine › Surgery › Salivary Gland Tumors Diagnosis and Treatment
Health Sciences › Medicine › Oncology › Neuroendocrine Tumor Research Advances
Keywords: branch duct intraductal papillary mucinous neoplasm, expectant management, cyst size, worrisome features, high-grade dysplasia, invasive carcinoma, carcinoma in situ, pancreatic ductal adenocarcinoma, pancreatic cysts, surgical resection
MeSH terms: Adenocarcinoma, Adult, Aged, Aged, 80 and over, Carcinoma in Situ, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pancreatectomy, Pancreatic Cyst, Pancreatic Ducts, Pancreatic Neoplasms, Retrospective Studies, Survival Rate, Practice Guidelines as Topic, Tumor Burden, Kaplan-Meier Estimate, Watchful Waiting, Neoplasm Grading

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Branch Duct Intraductal Papillary Mucinous Neoplasms: Does Cyst Size Change the Tip of the Scale? A Critical Analysis of the Revised International Consensus Guidelines in a Large Single-Institutional Series

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