Validation of the American Gastroenterological Association guidelines on management of intraductal papillary mucinous neoplasms: more than 5 years of follow-up

• Published in: European radiology Vol. 28; no. 1; pp. 170 - 178
• Main Authors: Imbe, Koh, Nagata, Naoyoshi, Hisada, Yuya, Takasaki, Yusuke, Sekine, Katsunori, Mishima, Saori, Kawazoe, Akihito, Tajima, Tsuyoshi, Shimbo, Takuro, Yanase, Mikio, Akiyama, Junichi, Fujimoto, Kazuma, Uemura, Naomi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2018; Springer Nature B.V
• Subjects: Aged; Cancer; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - pathology; Cohort analysis; Data processing; Decisions; Diagnostic Radiology; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods; Endosonography - methods; Female; Follow-Up Studies; Gastroenterology; Guidelines; Health risks; Hepatobiliary-Pancreas; Humans; Imaging; Indication; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms; Neuroradiology; Pancreatic cancer; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - pathology; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Patients; Radiology; Reproducibility of Results; Retrospective Studies; Risk; Societies, Medical; Surveillance; Tumors; Ultrasound; United States; United States; Pancreatic cyst; Pancreatic ductal carcinoma; Pancreatic neoplasms; Cohort studies; Validation studies
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-4966-x

Objectives Recent guidelines suggest that imaging surveillance be conducted for 5 years for patients with at most one high-risk feature. If there were no significant changes, surveillance is stopped. We sought to validate this follow-up strategy. Methods In study 1, data were analysed for 392 patients with intraductal papillary mucinous neoplasms (IPMNs) and at most one high-risk feature who were periodically followed up for more than 1 year with imaging tests. In study 2, data were analysed for 159 IPMN patients without worsening high-risk features after 5 years (stop surveillance group). Results In study 1, pancreatic cancer (PC) was identified in 12 patients (27.3%) in the endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) indication group and none in the non-EUS-FNA indication group ( P  < 0.01). In the EUS-FNA indication group, 11 patients (25%) died, whereas 29 (8.3%) died in the non EUS-FNA indication group ( P  < 0.01). In study 2 (stop surveillance group), PC was identified in three patients (1.9%) at 84, 103 and 145 months. Conclusions PC risk and mortality for IPMNs not showing significant change for 5 years is likely to be low, and the non-EUS-FNA indication can provide reasonable decisions. However, three patients without worsening high-risk features for 5 years developed PC. The stop surveillance strategy should be reconsidered. Key points • The AGA guidelines provide reasonable clinical decisions for the EUS-FNA indication. • In stop surveillance group, PC was identified in 3 patients (1.9%). • In stop surveillance group, 2 of 3 PC patients died from PC. • Risk of pancreatic cancer in “stop surveillance” group is not negligible.