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. 2018 Jun 13;9(6):158.
doi: 10.1038/s41424-018-0026-3.

Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature?

Maria Chiara Petrone  1 , Pietro Magnoni  2 , Ilaria Pergolini  3 , Gabriele Capurso  4 , Mariaemilia Traini  2 , Claudio Doglioni  5 , Alberto Mariani  2 , Stefano Crippa  6 , Paolo Giorgio Arcidiacono  2
Affiliations

Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature?

Maria Chiara Petrone et al. Clin Transl Gastroenterol. .

Erratum in

Abstract

Objectives: The management of branch-duct IPMN remains controversial due to the relatively low rate of malignant degeneration and the uncertain predictive role of high-risk stigmata (HRS) and worrisome features (WFs) identified by the 2012 International Consensus Guidelines. Our aim was to evaluate the evolution of originally low-risk (Fukuoka-negative) BD-IPMNs during a long follow-up period in order to determine whether the appearance of any clinical or morphological variables may be independently associated with the development of malignancy over time.

Methods: A prospectively collected database of all patients with BD-IPMN referring to our Institute between 2002 and 2016 was retrospectively analyzed. Univariate and multivariate analysis of association between changes during follow-up, including appearance of HRS/WFs, and development of malignancy (high-grade dysplasia/invasive carcinoma) was performed.

Results: A total of 167 patients were selected for analysis, and seven developed malignant disease (4.2%). During a median follow-up time of 55 months, HRS appeared in only three cases but predicted malignancy with 100% specificity. Worrisome features, on the other hand, appeared in 44 patients (26.3%). Appearance of mural nodules and MPD dilatation >5 mm showed a significant association with malignancy in multivariate analysis (p = 0.004 and p = 0.001, respectively). MPD dilatation in particular proved to be the strongest independent risk factor for development of malignancy (OR = 24.5).

Conclusions: The risk of pancreatic malignancy in this population is low but definite. The presence of major WFs, and especially MPD dilatation, should prompt a tighter follow-up with EUS and a valid cytological analysis whenever feasible.

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Conflict of interest statement

Guarantor of the article: Maria Chiara Petrone, MD.

Specific author contributions: Planning and conducting the study, collecting and interpreting data, and drafting the manuscript: Maria Chiara Petrone, Pietro Magnoni; performing the statistical analysis and interpreting data, Ilaria Pergolini; performing the statistical analysis, interpreting data, and critical review of the manuscript: Gabriele Capurso; conducting the study, collecting and interpreting data: Mariaemilia Traini, Claudio Doglioni, Alberto Mariani, Stefano Crippa; planning and conducting the study, interpreting data, and critical review of the manuscript: Paolo Giorgio Arcidiacono. All listed authors approved the final draft submitted.

Financial support: Gabriele Capurso received granting from AIRC (IG Grant 2015, 17177).

Potential competing interests: None.

Figures

Fig. 1
Fig. 1. Flow diagram illustrating the exclusion criteria applied to select cases for analysis.
HRS high-risk stigmata, WFs worrisome features
Fig. 2
Fig. 2. Kaplan–Meier curves showing progression-free survival in our low-risk branch-duct IPMN population over a 10-year period.
The events of interest were appearance of worrisome features (a) and development of malignancy (b), respectively
See this image and copyright information in PMC

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