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. 2015 Oct-Dec;28(4):487-94.

Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer

Robert D Lawson  1 , Gordon C Hunt  2 , Andrew Q Giap  3 , Mary L Krinsky  4 , Jeff Slezak  5 , Raymond S Tang  6 , Ingrid Gonzalez  7 , Wilson T Kwong  8 , Syed A Fehmi  8 , Thomas J Savides  8
Affiliations

Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer

Robert D Lawson et al. Ann Gastroenterol. 2015 Oct-Dec.

Abstract

Background: The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").

Methods: Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).

Results: After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).

Conclusions: This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.

Keywords: Pancreatic cyst; endosonography; intraductal papillary mucinous neoplasm; natural history; pancreatic cancer.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Patient screening, exclusion, and group assignment BD-IPMN, branch duct-intraductal papillary mucinous neoplasm; EUS, endoscopic ultrasound; HRG, highest-risk group; IPMN, intraductal papillary mucinous neoplasm; LRG, lowest-risk group
Figure 2
Figure 2
Cumulative incidence of pancreatic cancer in the highest (upper red line) and lowest (lower black line) risk groups
See this image and copyright information in PMC

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