| Theme |
The Current State of Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas |
| Title |
Practical Guidelines for IPMN |
| Author |
Tatsuji Yogi |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author |
Susumu Hijioka |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author |
Nobumasa Mizuno |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author |
Kazuo Hara |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author |
Hiroshi Imaoka |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author |
Kenji Yamao |
Department of Gastroenterology, Aichi Cancer Center Hospital |
| [ Summary ] |
In the revised guidelines, the criterion for characterizing main duct-type intraductal papillary mucinous neoplasms (MD-IPMN) has been lowered to a main pancreatic duct diameter (MPD) dilation of >5 mm. Surgical resection is recommended for MD-IPMN with MPD dilation ≥10 mm. However, a MPD dilation of 5-9 mm should be considered one of the "worrisome features", as is the case for branchduct (BD)-IPMN, with a recommendation for further surveillance, but no need for immediate surgical resection. "High-risk stigmata" and "worrisome features" have been used to stratify the risk of malignancy in BD-IPMN, and to consider early surgical resection or increased surveillance.
In Japan, some experts advocate continuation of surveillance every 6 months because of the relatively high incidence of pancreatic ductal adenocarcinoma in patients with BD-IPMN. The imaging findings (mural nodule, MPD dilatation, cyst size, thickened cyst walls) are used to distinguish malignant from benign BD-IPMNs, including the mixed-type IPMN. Preoperative pancreatic juice with MUC-staining may provide useful information for deciding on surgical intervention. |