Systematic review on surveillance for non-resected branch-duct intraductal papillary mucinous neoplasms of the pancreas.
Pancreatology
; 24(3): 463-488, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-38480047
ABSTRACT
BACKGROUND:
The management of branch-duct type intraductal papillary mucinous neoplasms (BD-IPMN) varies in existing guidelines. This study investigated the optimal surveillance protocol and safe discontinuation of surveillance considering natural history in non-resected IPMN, by systematically reviewing the published literature.METHODS:
This review was guided by PRISMA. Research questions were framed in PICO format "CQ1-1 Is size criteria helpful to determine surveillance period? CQ1-2 How often should surveillance be carried out? CQ1-3 When should surveillance be discontinued? CQ1-4 Is nomogram predicting malignancy useful during surveillance?". PubMed was searched from January-April 2022.RESULTS:
The search generated 2373 citations. After screening, 83 articles were included. Among them, 33 studies were identified for CQ1-1, 19 for CQ1-2, 26 for CQ1-3 and 12 for CQ1-4. Cysts <1.5 or 2 cm without worrisome features (WF) were described as more indolent, and most studies advised an initial period of surveillance. The median growth rate of cysts <2 cm ranged from 0.23 to 0.6 mm/year. Patients with cysts <2 cm showing no morphological changes and no WF after 5-years of surveillance have minimal malignancy risk of 0-2%. Two nomograms created with over 1000 patients had AUCs of around 0.8 and appear to be feasible in a real-world practice.CONCLUSIONS:
For patients with suspected BD-IPMN <2 cm and no other WF, less frequent surveillance is recommended. Surveillance may be discontinued for cysts that remain stable during 5-year surveillance, with consideration of patient condition and life expectancy. With this updated surveillance strategy, patients with non-worrisome BD-IPMN should expect more streamlined management and decreased healthcare utilization.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Pancreáticas
Limite:
Humans
Idioma:
En
Revista:
Pancreatology
Assunto da revista:
ENDOCRINOLOGIA
/
GASTROENTEROLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Coréia do Sul