From the Guidelines
The incidence of pancreatic cancer in patients with Intraductal Papillary Mucinous Neoplasm (IPMN) is significant, with approximately one-third of IPMNs associated with an invasive carcinoma.
Incidence of Pancreatic Cancer in IPMN
- The risk of malignancy in IPMNs is higher in main duct IPMNs, with a risk of around 62% 1.
- In contrast, the risk of malignancy in side branch IPMNs (SB-IPMNs) is lower, but still significant, with a risk of high-grade dysplasia or malignancy ranging from 30% to 59% depending on the dilatation of the main pancreatic duct 2.
Factors Influencing the Risk of Pancreatic Cancer in IPMN
- The presence of enhancing mural nodules, main pancreatic duct dilatation, and positive cytology for malignant high-grade dysplasia are absolute indications for surgery in IPMN patients 3.
- Relative indications for surgery include growth rate ≥5 mm/year, increased levels of serum CA 19.9, and cyst diameter ≥40 mm 3.
Management of IPMN
- The management of IPMN involves a multidisciplinary approach, with surgery being considered for patients with high-risk features or absolute indications for surgery 3, 4.
- Surveillance is considered an appropriate option for patients with low-risk features or those who are older or unfit for surgery 1, 3.
From the Research
Incidence of Pancreatic Cancer in Patients with Intraductal Papillary Mucinous Neoplasm (IPMN)
- The incidence of pancreatic cancer in patients with IPMN varies depending on the type of IPMN and the duration of follow-up.
- A study published in 2020 found that the overall incidence rates of pancreatic carcinoma in patients with branch-duct IPMN were 3.3%, 6.6%, and 15.0% at 5, 10, and 15 years, respectively 5.
- Another study published in 2015 found that the 5-year cumulative incidence of pancreatic malignancy in patients with branch-duct IPMN was 1.4% 6.
- A review of IPMN published in 2015 reported that the incidence of malignancy varies from 6% to 46% in branch-duct IPMN (BD-IPMN) 7.
Relationship between Side Branch Intraductal Papillary Mucinous Neoplasm (SB-IPMN) and Incidence of Pancreatic Cancer
- A study published in 2010 found that the 5-year and 10-year actuarial rates of development of pancreatic cancer in patients with SB-IPMN were 2.4% and 20.0%, respectively 8.
- Another study published in 2015 found that invasive adenocarcinoma was found in 12% of patients with SB-IPMN and non-malignant fine-needle aspiration (FNA) cytology, and high-grade dysplasia was found in 8% of patients 9.
- The presence of mural nodules and dilated main pancreatic duct (MPD) seem to be more appropriate indicators for resection than cyst size alone for SB-IPMNs 8.