Worrisome Features for Intraductal Papillary Mucinous Neoplasm: Should We be Worried.
Although worrisome features represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high
risk of malignancy. Pancreatic resection for worrisome imaging features often
demonstrates pathology consistent with low-grade dysplasia. Worrisome features should be considered as indicators of mostly low-grade dysplasia. High-risk stigmata are
more consistent for diagnosis of malignant lesions.
Pancreatic cystic neoplasms include different types of cysts with various biological behavior. The most prevalent are intraductal papillary mucinous neoplasm. The majority of IPMN is
located in the head of the pancreas. A single cystic mass as well as segmental involvement
or involvement of the entire pancreatic duct can be
Management of IPMN should focus on the prevention of malignant progression,
while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated
multidisciplinary teams. Worrisome features are indicated and described during
imaging study of IPMN.
These features, according to 2017 Fukuoka Consensus
Guidelines are cyst size ≥3 cm, thickened or enhancing cyst walls,
main duct size 5-9 mm, non-enhancing mural nodules, an abrupt
change in pancreatic duct caliber with distal pancreatic atrophy,
pancreatitis, and lymphadenopathy.
Although these data represent an indication to perform
endoscopic ultrasound study, recent studies have showed that these
conditions are not strictly related to high-risk of malignancy.
Izumo et al showed that an enhancing mural nodule
≥5 mm, pancreatitis, and thickened/enhancing cyst
walls were independent predictive factors for high-grade dysplasia. However,
none of worrisome features were pointed out.
Li et al described a good correlation for prediction
of high-grade dysplasia in presence of high-risk
Furthermore, pancreatic resection for worrisome imaging features often demonstrates pathology consistent with low-grade dysplasia.
Pancreas Open J. 2022; 5(1): e1-e2. doi: 10.17140/POJ-5-e013