4.7 Review

The Landmark Series: Intraductal Papillary Mucinous Neoplasms of the Pancreas-From Prevalence to Early Cancer Detection

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Summary: This study systematically reviewed the surveillance of low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) and investigated the incidence of worrisome features/high-risk stigmata (WF/HRS) and advanced neoplasia during the initial and extended surveillance period. The study found that low-risk, stable-sized BD-IPMNs had a lower incidence of advanced neoplasia during extended surveillance.

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Summary: This study found that serum apoA2-i has potential clinical value in risk stratification of IPMN and associated cancer. It showed higher accuracy and sensitivity in diagnosing IPMN-associated cancer compared to the routine biomarker CA 19-9. Further validation in larger and independent international cohort studies is needed for clinical application.

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Summary: This study investigated the natural history of IPMN and proposed optimal treatment strategies based on malignancy risk prediction using a nomogram and decision model. Main duct and mixed-type IPMN have a high risk of malignancy (79.9%) and surgery is recommended, while branch duct IPMN is very indolent (5.9%) and surveillance may be appropriate. Decision-making regarding surgery or surveillance should consider patients' health status, malignancy risk, and institutional experience.

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