Management of intraductal papillary mucinous neoplasms of the pancreas

Abstract

Over the last decade, the diagnosis and treatment of intraductal papillary mucinous tumors (IPMN) of the pancreas has evolved. They represent a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. Several non-invasive and invasive imaging modalities allow adequate visualization of these lesions. Multidetec-tor computed tomography (MCT) and magnetic resonance (MR) Cholangiopan-creatography are generally used as fist line imaging techniques, whereas invasive techniques as endoscopic ultrasound or endoscopic retrograde cholangiopancreatography are usually considered in the setting of an uncertain diagnosis. Multiple factors have to be taken into consideration in order to establish an adequate management of these lesions. Main duct and combined IPMN, as well as branch duct lesions larger than 3 cm or containing aggressive features as solid component are considered indications for surgical resection. On the other hand, follow-up through imaging is advocated for small, benign appearing lesions, as well as for post-surgical patients. In the later setting, the follow-up protocol should consider the aggressiveness of the resected lesion and the surgical margins, in order to establish an optimal time interval of imaging.