Eizaburo Ohno1, Yoshiki Hirooka2, Hiroki Kawashima1, Takuya Ishikawa1, Akira Kanamori3, Hideki Ishikawa4, Yoji Sasaki5, Koji Nonogaki6, Kazuo Hara7, Senju Hashimoto8, Hiroshi Matsubara9, Takanori Hirai10, Hajime Sumi11, Hiroyuki Sugimoto12, Hidemi Goto1. 1. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan. 3. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan. 4. Department of Gastroenterology, Public Nishichita General Hospital, Tokai, Aichi, Japan. 5. Department of Gastroenterology, Konan Kousei Hospital, Konan, Aichi, Japan. 6. Department of Gastroenterology, Daido Hospital, Nagoya, Japan. 7. Department of Gastroenterology, Aichi Cancer Centre Hospital, Nagoya, Japan. 8. Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan. 9. Department of Gastroenterology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan. 10. Department of Gastroenterology, Komaki Municipal Hospital, Komaki, Aichi, Japan. 11. Department of Gastroenterology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan. 12. Department of Gastroenterology, Handa City Hospital, Handa, Aichi, Japan.
Abstract
BACKGROUND AND AIM: The aim of this study is to elucidate the natural history of pancreatic cystic lesions (PCLs), including branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN), via midterm follow-up analysis of a multicenter prospective observational study (NSPINAL study). METHODS: From July 2011 to October 2016, 881 patients with PCLs were enrolled in NSPINAL study, and 664 patients with > 12 months of follow up were analyzed. Every patient was asymptomatic, and endoscopic ultrasound was performed at the initial diagnosis to exclude high-risk individuals. Follow up included endoscopic ultrasound, computed tomography, or magnetic resonance imaging at least once a year. Serial morphological changes and the pancreatic cancer (PC) incidence, including malignant progression of PCLs, were evaluated. RESULTS: The 664 patients (358 men) were followed for a median of 33.5 months (interquartile range 29). The cyst and main pancreatic duct sizes were 16.6 ± 9.3 and 2.3 ± 1.0 mm, respectively. Morphologically, 518 cases were multilocular, 137 were unilocular, and 9 had a honeycomb pattern; 269 cases involved multifocal lesions. Ninety-six patients (14.5%) showed worsening progression on imaging. There were two resectable and four unresectable cases of pancreatic ductal adenocarcinoma and three cases of malignant BD-IPMN. The 3-year risk of developing PC was 1.2%. The standardized incidence ratio for PC among PCLs was 10.0 (95% confidence interval 3.5-16.5), and the standardized incidence ratio among BD-IPMN was 16.6 (95% confidence interval 5.1-28.1). Multivariate analysis showed that development of symptoms and worsening progression were significant predictors of PC. CONCLUSIONS: Malignant progression of PCLs, including PC development, is not uncommon. Patients with PCLs should be carefully monitored to detect pancreatic ductal adenocarcinoma at early stages.
BACKGROUND AND AIM: The aim of this study is to elucidate the natural history of pancreatic cystic lesions (PCLs), including branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN), via midterm follow-up analysis of a multicenter prospective observational study (NSPINAL study). METHODS: From July 2011 to October 2016, 881 patients with PCLs were enrolled in NSPINAL study, and 664 patients with > 12 months of follow up were analyzed. Every patient was asymptomatic, and endoscopic ultrasound was performed at the initial diagnosis to exclude high-risk individuals. Follow up included endoscopic ultrasound, computed tomography, or magnetic resonance imaging at least once a year. Serial morphological changes and the pancreatic cancer (PC) incidence, including malignant progression of PCLs, were evaluated. RESULTS: The 664 patients (358 men) were followed for a median of 33.5 months (interquartile range 29). The cyst and main pancreatic duct sizes were 16.6 ± 9.3 and 2.3 ± 1.0 mm, respectively. Morphologically, 518 cases were multilocular, 137 were unilocular, and 9 had a honeycomb pattern; 269 cases involved multifocal lesions. Ninety-six patients (14.5%) showed worsening progression on imaging. There were two resectable and four unresectable cases of pancreatic ductal adenocarcinoma and three cases of malignant BD-IPMN. The 3-year risk of developing PC was 1.2%. The standardized incidence ratio for PC among PCLs was 10.0 (95% confidence interval 3.5-16.5), and the standardized incidence ratio among BD-IPMN was 16.6 (95% confidence interval 5.1-28.1). Multivariate analysis showed that development of symptoms and worsening progression were significant predictors of PC. CONCLUSIONS: Malignant progression of PCLs, including PC development, is not uncommon. Patients with PCLs should be carefully monitored to detect pancreatic ductal adenocarcinoma at early stages.
Authors: Johannes F Fahrmann; C Max Schmidt; Xiangying Mao; Ehsan Irajizad; Maureen Loftus; Jinming Zhang; Nikul Patel; Jody Vykoukal; Jennifer B Dennison; James P Long; Kim-Anh Do; Jianjun Zhang; John A Chabot; Michael D Kluger; Fay Kastrinos; Lauren Brais; Ana Babic; Kunal Jajoo; Linda S Lee; Thomas E Clancy; Kimmie Ng; Andrea Bullock; Jeanine Genkinger; Michele T Yip-Schneider; Anirban Maitra; Brian M Wolpin; Samir Hanash Journal: Gastroenterology Date: 2020-12-14 Impact factor: 22.682
Authors: Kasper A Overbeek; Nikki van Leeuwen; Matteo Tacelli; Muhammad S Anwar; Muhammad N Yousaf; Ankit Chhoda; Paolo Giorgio Arcidiacono; Tamas A Gonda; Michael B Wallace; Gabriele Capurso; James J Farrell; Djuna L Cahen; Marco J Bruno Journal: United European Gastroenterol J Date: 2022-02-24 Impact factor: 4.623
Authors: Alberto Balduzzi; Giovanni Marchegiani; Marco Zampese; Roberto Salvia Journal: United European Gastroenterol J Date: 2022-02-11 Impact factor: 4.623