Tan Hwee-Leong, Hee Jonathan, Wu Jania, Lim Grace R S, Tan Damien M Y, Low Albert S, Thng Choon-Hua, Koh Ye-Xin, Goh Brian K P
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital & National Cancer Centre Singapore, Singapore.
Ministry of Health Holdings, Singapore.
Pancreatology. 2024 Dec;24(8):1332-1339. doi: 10.1016/j.pan.2024.11.014. Epub 2024 Nov 20.
The optimal surveillance strategy for low-risk branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) remains unclear. We aim to evaluate the natural history of low-risk BD-IPMN/indeterminate pancreatic cysts to determine optimal surveillance intervals.
We conducted a retrospective cohort study of patients with radiologically-diagnosed low-risk BD-IPMN/indeterminate pancreatic cysts from 1998 to 2021 at a tertiary referral center. Low-risk BD-IPMN, worrisome features (WF) and high-risk stigmata (HRS) were defined as per existing guidelines. Patients were grouped into three categories based on cyst size at diagnosis: <10 mm, 10-19 mm and 20-29 mm. The size distribution and cumulative incidence of WF and HRS development were charted annually for the first five years.
We studied 1668 patients, with 794 (47.6 %), 652 (39.1 %) and 222 (13.3 %) with cysts <10 mm, 10-19 mm and 20-29 mm at baseline respectively. Overall WF and HRS development was seen in 11.7 % and 1.4 % of patients respectively, with higher proportion of WF (6.8 vs 9.8 vs 34.7 %, p < 0.001) and HRS (0.9 vs 1.4 vs 3.6 %, p = 0.011) development with increasing baseline size category. Cysts <10 mm had 94.3 % < 30 mm at five years, 2.0 % WF at one year and a single case of HRS at two years. Cysts 10-19 mm had 94.7 % < 30 mm at five years, 2.2 % WF at one year and the first incident case of HRS at one year. Cysts 20-29 mm had 63.8 % < 30 mm at five years, 9.5 % WF and 1.1 % (4 cases) HRS by one year.
Baseline cyst size can be used to guide surveillance intervals for low-risk BD-IPMN/indeterminate pancreatic cysts.
低风险分支导管内乳头状黏液性肿瘤（BD-IPMN）的最佳监测策略仍不明确。我们旨在评估低风险BD-IPMN/不确定胰腺囊肿的自然病程，以确定最佳监测间隔。
我们在一家三级转诊中心对1998年至2021年经放射学诊断为低风险BD-IPMN/不确定胰腺囊肿的患者进行了一项回顾性队列研究。根据现有指南定义低风险BD-IPMN、可疑特征（WF）和高风险征象（HRS）。根据诊断时囊肿大小将患者分为三类：<10mm、10-19mm和20-29mm。在最初五年中，每年绘制WF和HRS发生情况的大小分布及累积发生率。
我们研究了1668例患者，基线时囊肿<10mm、10-19mm和20-29mm的分别有794例（47.6%）、652例（39.1%）和222例（13.3%）。总体而言，分别有11.7%和1.4%的患者出现WF和HRS，随着基线囊肿大小类别增加，WF（6.8%对9.8%对34.7%，p<0.001）和HRS（0.9%对1.4%对3.6%，p=0.011）发生比例更高。<10mm的囊肿在五年时94.3%<30mm，一年时WF发生率为2.0%，两年时有1例HRS。10-19mm的囊肿在五年时94.7%<30mm，一年时WF发生率为2.2%，一年时首次出现HRS病例。20-29mm的囊肿在五年时63.8%<30mm，一年时WF发生率为9.5%，HRS发生率为1.1%（4例）。
基线囊肿大小可用于指导低风险BD-IPMN/不确定胰腺囊肿的监测间隔。
