The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.
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
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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“While the goal of surgery is to resect lesions with advanced neoplasia (high-grade dysplasia and/or adenocarcinoma), approximately 42–63% of resected IPMNs were found to have only low-grade dysplasia [12,13,14,15,16,17].”
From Artificial Intelligence in the Diagnosis and Treatment of Pancreatic Cystic Lesions and Adenocarcinoma (2023) · cites this paper as [15]
In the citing paper
“up to 78% of individuals with branch duct intraductal papillary mucinous neoplasms that undergo surgical resection do not have high-grade dysplasia or pancreatic ductal adenocarcinoma and in hindsight did not require surgery.40”
From Early detection of pancreatic cancer (2020) · cites this paper as [40]
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Self-citationTanaka, M., Chari, S. T., Adsay, V. N., Carlos, F.-D., Falconi, M., Shimizu, M., Yamaguchi, K., Yamao, K., & Matsuno, S. (2005) · Pancreatology · doi:10.1159/000090023 · Cited by 2,042
Cystic Neoplasms of the Pancreas
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Natural History of Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas
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Small (Sendai Negative) Branch-Duct IPMNs
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Branch duct intraductal papillary mucinous neoplasms in a retrospective series of 190 patients
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Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas
Tanaka, M., Fernández-del Castillo, C., Kamisawa, T., Jang, J. Y., Levy, P., Ohtsuka, T., Salvia, R., Shimizu, Y., Tada, M., & Wolfgang, C. L. (2017) · Pancreatology · doi:10.1016/j.pan.2017.07.007 · Cited by 1,797
European evidence-based guidelines on pancreatic cystic neoplasms
The European Study Group on Cystic Tumours of the Pancreas (2018) · Gut · doi:10.1136/gutjnl-2018-316027 · Cited by 1,417
ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts
Elta, G. H., Enestvedt, B. K., Sauer, B. G., & Lennon, A. M. (2018) · The American Journal of Gastroenterology · doi:10.1038/ajg.2018.14 · Cited by 734
Early detection of pancreatic cancer
Pereira, S. P., Oldfield, L., Ney, A., Hart, P. A., Keane, M. G., Pandol, S. J., Li, D., Greenhalf, W., Jeon, C. Y., Koay, E. J., et al. (2020) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(19)30416-9 · Cited by 482
Springer, S., Wang, Y., Dal Molin, M., Masica, D. L., Jiao, Y., Kinde, I., Blackford, A., Raman, S. P., Wolfgang, C. L., Tomita, T., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.07.041 · Cited by 477
Self-citation
Metadata
- 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
- Venue
- Annals of Surgery
- Published
- 2013-09
- Volume
- 258
- Issue
- 3
- Pages
- 466-475
- ISSN
- 0003-4932 (ISSN-L)
- 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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