Rautou Pierre-Emmanuel, Lévy Phillippe, Vullierme Marie-Pierre, O'Toole Dermot, Couvelard Anne, Cazals-Hatem Dominique, Palazzo Laurent, Aubert Alain, Sauvanet Alain, Hammel Pascal, Hentic Olivia, Rebours Vinciane, Pelletier Anne-Laure, Maire Frédérique, Ruszniewski Phillippe
Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, France.
Clin Gastroenterol Hepatol. 2008 Jul;6(7):807-14. doi: 10.1016/j.cgh.2007.12.021. Epub 2008 Mar 4.
BACKGROUND & AIMS: Because there is a low risk of malignancy for intraductal papillary and mucinous neoplasms of the pancreas (IPMNs) confined to branch ducts (BD), patient follow-up evaluation without surgery is possible. The aim of this study was to assess time-related morphologic changes and risk of progress to malignancy in patients with BD IPMN. A prospective design was used in an academic tertiary referral center.
All consecutive patients seen from 1999 to 2005 with highly suspected IPMNs confined to BD without criteria suggesting a malignant development (mural nodule, cyst wall thickness >2 mm, BD diameter >30 mm, or main pancreatic duct involvement) were followed up prospectively using computerized tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography.
A total of 121 patients (median age, 63 y) were included. After a median follow-up period of 33 months, no morphologic changes had occurred in 88 patients. The size of the cyst increased in 30 of the 33 remaining patients, and 12 developed criteria suggesting a malignant development. Surgery, performed in 8 of 12 patients, found 4 IPMN-adenomas, 1 borderline-IPMN, and 4 IPMN carcinoma in situ. The 4 remaining patients did not undergo surgery because of severe comorbid conditions in 2, change in reference hospital in 1, and a mural nodule considered being sequelae of previous fine-needle aspiration in 1 patient. The only factor associated with signs suggesting malignant development was an increase in cyst size to more than 5 mm during the follow-up evaluation.
In patients with IPMNs confined to BD, morphologic changes are rare events, justifying a nonsurgical approach. Careful follow-up evaluation remains necessary, particularly in patients with an increase in BD size.
由于局限于分支导管（BD）的胰腺导管内乳头状黏液性肿瘤（IPMN）发生恶性病变的风险较低，因此对患者可不进行手术而进行随访评估。本研究旨在评估BD-IPMN患者与时间相关的形态学变化以及进展为恶性病变的风险。在一家学术性三级转诊中心采用前瞻性设计。
对1999年至2005年期间连续就诊的所有高度怀疑为局限于BD的IPMN且无提示恶性进展标准（壁结节、囊肿壁厚度>2mm、BD直径>30mm或主胰管受累）的患者，采用计算机断层扫描、磁共振胰胆管造影和内镜超声进行前瞻性随访。
共纳入121例患者（中位年龄63岁）。中位随访期33个月后，有88例患者未发生形态学变化。其余33例患者中有30例囊肿大小增加，12例出现提示恶性进展的标准。12例患者中有8例接受了手术，发现4例IPMN腺瘤、1例交界性IPMN和4例原位IPMN癌。其余4例患者未接受手术，原因分别为2例存在严重合并症、1例转诊至其他医院以及1例患者的壁结节被认为是先前细针穿刺的后遗症。与提示恶性进展体征相关的唯一因素是随访评估期间囊肿大小增加至超过5mm。
对于局限于BD的IPMN患者，形态学变化很少见，因此非手术方法是合理的。仍有必要进行仔细的随访评估，尤其是BD大小增加的患者。
