Mandal Amrendra K, Eisinger Amanda, Doolittle Tessa, Ghosh Auyon, Aswath Ganesh, John Savio, Sapkota Bishnu
Department of Gastroenterology, SGMC Health, Valdosta, Georgia, USA.
Department of Gastroenterology, Mercer University School of Medicine, Macon, Georgia, USA.
Eur J Gastroenterol Hepatol. 2025 Oct 1;37(10):1117-1121. doi: 10.1097/MEG.0000000000003004. Epub 2025 May 20.
Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cystic lesions with variable risk for malignant transformation. This observational study assessed the long-term natural history of IPMNs, focusing on risk stratification based on imaging and histological features.
We retrospectively reviewed 93 patients with IPMN confirmed by MRI and endoscopic ultrasound (EUS) or both. All patients had a minimum follow-up of 5 years. Demographic, clinical, imaging, procedural, and outcome data were collected. IPMN characteristics including cyst size, duct size, duct involvement, and location were evaluated at baseline. The primary outcome was progression to high-grade dysplasia or invasive carcinoma. Secondary outcomes included the need for surgery, cyst progression, and IPMN-related mortality.
The cohort included 93 patients (65.6% female, mean age 70.9 ± 9.9 years). The majority (92.5%) had branch duct IPMN. The mean cyst size was 1.53 ± 1.57 cm, and the duct size was 2.69 ± 1.79 mm. High-grade dysplasia was found in 9.7%. Surgical resection was significantly associated with cyst size >2.6 cm ( P = 0.031), duct dilation >5.3 mm ( P = 0.004), and main/mixed duct involvement ( P < 0.001). Additionally, cyst wall thickening (60%) and mural nodule (67%) were significantly associated with surgical resection. One patient progressed to invasive carcinoma. No IPMN-related deaths were reported.
IPMNs evaluated and monitored with MRI/EUS demonstrate indolent behavior over extended follow-up. Surgical resection should be considered based on duct type, cyst size, and presence of dysplasia. Long-term surveillance remains essential for appropriate risk stratification.
导管内乳头状黏液性肿瘤（IPMNs）是具有不同恶性转化风险的胰腺囊性病变。这项观察性研究评估了IPMNs的长期自然病史，重点是基于影像学和组织学特征的风险分层。
我们回顾性分析了93例经MRI和内镜超声（EUS）或两者确诊的IPMN患者。所有患者的随访时间至少为5年。收集了人口统计学、临床、影像学、手术及结局数据。在基线时评估IPMN的特征，包括囊肿大小、导管大小、导管受累情况及位置。主要结局是进展为高级别异型增生或浸润性癌。次要结局包括手术需求、囊肿进展及IPMN相关死亡率。
该队列包括93例患者（女性占65.6%，平均年龄70.9±9.9岁）。大多数（92.5%）为分支导管IPMN。平均囊肿大小为1.53±1.57cm，导管大小为2.69±1.79mm。高级别异型增生的发生率为9.7%。手术切除与囊肿大小>2.6cm（P=0.031）、导管扩张>5.3mm（P=0.004）及主/混合导管受累（P<0.001）显著相关。此外，囊肿壁增厚（60%）和壁结节（67%）与手术切除显著相关。1例患者进展为浸润性癌。未报告IPMN相关死亡病例。
经MRI/EUS评估和监测的IPMNs在长期随访中表现出惰性。应根据导管类型、囊肿大小及异型增生情况考虑手术切除。长期监测对于适当的风险分层仍然至关重要。
