Balancing malignancy risk and healthcare resources: Optimizing surveillance for branch-duct intraductal papillary mucinous neoplasm

doi:10.3748/wjg.121301

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Oct 28, 2026; 32(40): 121301
Published online Oct 28, 2026. doi: 10.3748/wjg.121301

Balancing malignancy risk and healthcare resources: Optimizing surveillance for branch-duct intraductal papillary mucinous neoplasm

Yi-Ning Zhang, Jin-Nian Duan, Ntim Michael, Ying Wang, De-Fang Chen, Bin Wang

Yi-Ning Zhang, Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, Dalian 116000, Liaoning Province, China

Jin-Nian Duan, Bin Wang, Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China

Ntim Michael, Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ashanti, Ghana

Ying Wang, Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, The Second Affiliated Hospital, Dalian Medical University, Dalian 116000, Liaoning Province, China

De-Fang Chen, Emergency Intensive Care Unit, Qingpu Branch of Zhongshan Hospital, Shanghai 201700, Shanghai Province, China

Co-first authors: Yi-Ning Zhang and Jin-Nian Duan.

Co-corresponding authors: De-Fang Chen and Bin Wang.

Author contributions: Zhang YN, Duan JN contributed equally as co-first authors, while Chen DF and Wang B shared responsibilities as co-corresponding authors; Zhang YN and Duan JN were primarily responsible for the conceptualization and design of this editorial, conducting an extensive literature review, synthesizing key insights, drafting the manuscript, and completing subsequent revisions. They played a critical role in shaping the structure, identifying key issues, and ensuring that the discussion was both comprehensive and thought-provoking; Chen DF and Wang B are the co-corresponding authors. They supervised the entire process, offering valuable intellectual guidance and ensuring the scientific rigor of the editorial. They were actively involved in multiple rounds of manuscript revision, providing constructive critiques and refining key arguments to enhance clarity and impact. Additionally, Wang Y made important contributions to literature screening, reference management, and assisting in structuring the manuscript, which improved its clarity and coherence; Wang B also played an essential role in securing institutional support for this work and facilitating access to relevant research resources; Michael N contributed to language editing and to the completion of the manuscript. This collaboration brought together diverse expertise, resulting in a well-rounded and insightful editorial; all authors made significant and indispensable contributions.

AI contribution statement: ChatGPT was used solely for language polishing to improve readability and expression. It was not involved in generating any scientific content, data, interpretations, or conclusions, nor was it used in the preparation of any figures or images.

Supported by the Liaoning Province Natural Science Foundation Project, No. 2024-MS-157; National Natural Science Foundation of China, No. 82301700; and Research Topic of the Shanghai Qingpu District Health Commission, No. QWJ2024-10.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Corresponding author: Bin Wang, PhD, Professor, Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, No. 9 West Section, Lvshun South Road, Dalian 116000, Liaoning Province, China. wb101900@126.com

Received: March 23, 2026
Revised: April 12, 2026
Accepted: April 22, 2026
Published online: October 28, 2026
Processing time: 172 Days and 19.6 Hours

Abstract

The rising use of cross-sectional imaging has led to increased detection of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs), posing a clinical challenge in balancing cancer prevention against the risks and costs of long-term surveillance. A recent multicenter study by Kayali et al published in World Journal of Gastroenterology, proposed data-driven cyst size thresholds (1.5 cm and 3 cm) and suggested that the presence of at least two worrisome features may enhance the prediction of malignant progression. While these evidence-based refinements offer a pragmatic step toward cost-effective care, they also highlight the inherent limitations of morphology-based surveillance. Emerging approaches including radiomics, artificial intelligence-assisted imaging analysis, and circulating biomarkers (e.g., cell-free DNA or cyst fluid molecular profiling) hold potential to improve individualized risk assessment beyond conventional imaging criteria. Moreover, the growing prevalence of incidental pancreatic cysts in aging populations necessitates the integration of life expectancy, comorbidities, and patient preferences into surveillance planning. Finally, international variability in healthcare resources calls for validation of surveillance strategies across diverse systems. Together, these considerations highlight the need to advance from size-based criteria toward multidimensional, precision-based risk stratification in BD-IPMN management.

Keywords: Branch-duct intraductal papillary mucinous neoplasm; Pancreatic cystic neoplasms; Risk stratification; Imaging surveillance; Radiomics; Molecular biomarkers

Core Tip: Recent data-driven analyses offer new insights into the surveillance of branch-duct intraductal papillary mucinous neoplasm. A multicenter study highlights refined cyst size thresholds and the value of multiple worrisome features in predicting malignancy. However, morphology-based surveillance alone cannot fully assess biological heterogeneity. Emerging approaches, including radiomics, artificial intelligence-based imaging, and fluid or blood biomarkers, may supplement current imaging criteria. Integrating these advances with patient-specific factors could enable more precise and individualized management in the future.