Accuracy and predictive value of the “worrisome features” for the management of Branch duct intraductal papillary mucinous cystic neoplasms

Abstract

Background: The incidence of intraductal papillary cystic mucinous neoplasm (IPMN) of the pancreas is rapidly increasing. While the surgical indications for main duct (MD) and mixed type (MT) neoplasms are considered straightforward, the management of branch duct (BD) IPMN is still controversial Methods: A database of 256 patients (mean follow-up 54.4 months) undergoing imaging surveillance for BD-IPMN at our Centre was searched: in accordance with updated management guideline recommendations, 12 patients who underwent surgery were compared with 24 who had similar demographic characteristics, but still under surveillance. A case/control study was performed. Results: The incidence of non-enhancing mural nodules (MN), dilatation of the main pancreatic duct (MPD) between 5-9 mm and the evidence of thickened/enhanced cyst walls proved to be higher in the surgery group, and the difference was statistically significant. In addition, cases of abrupt changes in the mean cyst diameter over time were more often reported in the surgery group. The presence of MN on preoperative imaging investigations was found correlating with intermediate and high-grade dysplasia. Conclusion: Although the reliability of the updated consensus guidelines in detecting patients who really need to be operated is well assessed, decisions concerning the type and timing of surveillance examinations’ schedule schedule need to be evaluated using a case by case method and a multidisciplinary approach (tailored therapy).