Tashiro Yuki, Kachi Mana, Hashimoto Toshi, Takeyama Nobuyuki, Ueda Yasuo, Munechika Jiro, Ohgiya Yoshimitsu
Showa University Fujigaoka Hospital, Yokohama, Japan.
Showa University, Tokyo, Japan.
Abdom Radiol (NY). 2025 Jun 16. doi: 10.1007/s00261-025-04996-8.
Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic neoplasm of the pancreas, encompassing a spectrum from benign to malignant lesions. Recently, the international guidelines for IPMN management were revised as the Kyoto guidelines, emphasizing the critical role of imaging in diagnosis, risk assessment, and surveillance. This article provides a comprehensive review of IPMN based on the updated guidelines, focusing on imaging-related aspects while elucidating the underlying pathological background. We present the three interrelated classification systems for IPMN: anatomical location (branch-duct, main-duct, or mixed type), histological subtype (gastric, intestinal, or pancreatobiliary), and degree of dysplasia (low-grade, high-grade, or associated invasive carcinoma). Understanding these classifications and their correlations is fundamental for imaging-based risk assessment and clinical decision-making. We discuss the two distinct carcinogenesis patterns in IPMN-sequential pattern resulting in high-grade dysplasia or invasive carcinoma associated with IPMN, and concomitant pattern leading to pancreatic ductal adenocarcinoma in IPMN-harboring pancreas. The article reviews high-risk stigmata and worrisome features that guide risk stratification, providing illustrative examples and highlighting potential diagnostic pitfalls. We also examine differential diagnoses including serous cystic neoplasm, mucinous cystic neoplasm, pancreatic intraepithelial neoplasia, pseudocysts, and large duct type pancreatic ductal adenocarcinoma. Finally, we review the current management algorithm and surveillance methods recommended by the Kyoto guidelines. This review aims to enhance radiologists' and clinicians' understanding of IPMN by integrating pathological knowledge with imaging findings, emphasizing that while high-risk stigmata are strong predictors of high-grade dysplasia or invasive carcinoma, surgical decisions should be individualized considering multiple factors including patient preferences, comorbidities, and life expectancy.
导管内乳头状黏液性肿瘤（IPMN）是胰腺最常见的囊性肿瘤，涵盖了从良性到恶性病变的一系列情况。最近，IPMN管理的国际指南被修订为京都指南，强调了影像学在诊断、风险评估和监测中的关键作用。本文基于更新后的指南对IPMN进行了全面综述，重点关注与影像学相关的方面，同时阐明其潜在的病理背景。我们介绍了IPMN的三种相互关联的分类系统：解剖位置（分支导管型、主胰管型或混合型）、组织学亚型（胃型、肠型或胰胆管型）和发育异常程度（低级别、高级别或伴有浸润性癌）。理解这些分类及其相关性是基于影像学的风险评估和临床决策的基础。我们讨论了IPMN中两种不同的致癌模式——导致与IPMN相关的高级别发育异常或浸润性癌的序贯模式，以及在含有IPMN的胰腺中导致胰腺导管腺癌的伴随模式。本文回顾了指导风险分层的高危征象和令人担忧的特征，提供了示例并强调了潜在的诊断陷阱。我们还研究了鉴别诊断，包括浆液性囊性肿瘤、黏液性囊性肿瘤、胰腺上皮内瘤变、假性囊肿和大导管型胰腺导管腺癌。最后，我们回顾了京都指南推荐的当前管理算法和监测方法。本综述旨在通过将病理知识与影像学结果相结合，增强放射科医生和临床医生对IPMN的理解，强调虽然高危征象是高级别发育异常或浸润性癌的有力预测指标，但手术决策应考虑包括患者偏好、合并症和预期寿命等多种因素进行个体化。
