Jabłońska B, Szmigiel P, Mrowiec S. Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management. World J Gastrointest Oncol 2021; 13(12): 1880-1895 [PMID: 35070031 DOI: 10.4251/wjgo.v13.i12.1880]
Corresponding Author of This Article
Beata Jabłońska, MD, PhD, Adjunct Professor, Department of Digestive Tract Surgery, Medical University of Silesia, Medyków 14, Katowice 40-752, Poland. bjablonska@poczta.onet.pl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Dec 15, 2021; 13(12): 1880-1895 Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.1880
Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management
Beata Jabłońska, Paweł Szmigiel, Sławomir Mrowiec
Beata Jabłońska, Paweł Szmigiel, Sławomir Mrowiec, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice 40-752, Poland
Author contributions: Jabłońska B reviewed the literature and drafted the manuscript; Szmigiel P reviewed the literature; Mrowiec S revised the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Beata Jabłońska, MD, PhD, Adjunct Professor, Department of Digestive Tract Surgery, Medical University of Silesia, Medyków 14, Katowice 40-752, Poland. bjablonska@poczta.onet.pl
Received: February 22, 2021 Peer-review started: February 22, 2021 First decision: June 4, 2021 Revised: June 17, 2021 Accepted: October 18, 2021 Article in press: October 18, 2021 Published online: December 15, 2021
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) represent approximately 1% of all pancreatic neoplasms and 25% of cystic neoplasms. They are divided into three types: main duct-IPMN (MD-IPPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN. In this review, diagnostics, including clinical presentation and radiological investigations, were described. Magnetic resonance imaging is the most useful for most IPMNs. Management depends on the type and radiological features of IPMNs. Surgery is recommended for MD-IPMN. For BD-IPMN, management involves surgery or surveillance depending on the tumor size, cyst growth rate, solid components, main duct dilatation, high-grade dysplasia in cytology, the presence of symptoms (jaundice, new-onset diabetes, pancreatitis), and CA 19.9 serum level. The patient’s age and comorbidities should also be taken into consideration. Currently, there are different guidelines regarding the diagnosis and management of IPMNs. In this review, the following guidelines were presented: Sendai International Association of Pancreatology guidelines (2006), American Gastroenterological Association guidelines, revised international consensus Fukuoka guidelines (2012), revised international consensus Fukuoka guidelines (2017), and European evidence-based guidelines according to the European Study Group on Cystic Tumours of the Pancreas (2018). The Verona Evidence-Based Meeting 2020 was also presented and discussed.
Core Tip: Intraductal papillary mucinous neoplasms (IPMNs) account about 1% of all pancreatic neoplasms and 25% of cystic neoplasms. We can distinguish three IPMN types: main duct-IPMN (MD-IPPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN. Magnetic resonance imaging is the most useful approach for most IPMNs. Management depends on the type and radiological features of IPMNs. MD-IPMN is recommended for surgery. In BD-IPMN, management involves surgery or surveillance depending on the tumor size, cyst growth rate, solid components, main duct dilatation, high-grade dysplasia in cytology, the presence of symptoms (jaundice, new-onset diabetes, pancreatitis), and CA 19.9 serum level. The patient’s age and comorbidities should also be taken into consideration. Currently, there are different guidelines regarding the diagnostics and management of IPMNs: Sendai International Association of Pancreatology guidelines (2006), American Gastroenterological Association guidelines, revised international consensus Fukuoka guidelines (2012), revised international consensus Fukuoka guidelines (2017), and European evidence-based guidelines based on the European Study Group on Cystic Tumors of the Pancreas (2018). The experts of Verona Evidence-Based Meeting 2020 determined the most important further directions regarding guidelines on IPMN management.
