TY - JOUR
T1 - Intraductal papillary mucinous neoplasms in high-risk individuals
T2 - incidence, growth rate, and malignancy risk
AU - Overbeek, Kasper A
AU - Koopmann, Brechtje D M
AU - the Dutch Familial Pancreatic Cancer Surveillance Study Group
AU - Levink, Iris J M
AU - Tacelli, Matteo
AU - Erler, Nicole S
AU - Arcidiacono, Paolo Giorgio
AU - Ausems, Margreet G E
AU - Wagner, Anja
AU - van Eijck, Casper H
AU - Koerkamp, Bas Groot
AU - Busch, Olivier R
AU - Besselink, Marc G
AU - van der Vlugt, Manon
AU - van Driel, Lydi M J W
AU - Fockens, Paul
AU - Vleggaar, Frank P
AU - Poley, Jan-Werner
AU - Capurso, Gabriele
AU - Cahen, Djuna L
AU - Bruno, Marco J
N1 - Publisher Copyright:
© 2024 AGA Institute
PY - 2024/1
Y1 - 2024/1
N2 - BACKGROUND AND AIMS: In high-risk individuals (HRIs), we aimed to assess the cumulative incidence of intraductal papillary mucinous neoplasms (IPMNs) and compare IPMN growth, neoplastic progression rate, and the value of growth as predictor for neoplastic progression to these in sporadic IPMNs.METHODS: We performed annual surveillance of Dutch HRIs, involving carriers of germline pathogenic variants (PV) and PV-negative familial pancreatic cancer (FPC) kindreds. HRIs with IPMNs were compared to Italian individuals without familial risk under surveillance for sporadic IPMNs.RESULTS: 457 HRIs were followed for 48 months (range 2-172); the estimated cumulative IPMN incidence was 46% (95%CI 28-64). In comparison to 442 controls, IPMNs in HRIs were more likely to grow ≥ 2.5 mm/year (31% versus 7%, P<0.001) and to develop worrisome features (32% versus 19%, P=0.010). PV carriers with IPMNs more often displayed neoplastic progression (n=3, 11%; versus n=6, 1%; P=0.011), while FPC kindreds did not (n=0, 0%; P=1.000). The malignancy risk in a PV carrier with an IPMN was 23% for growth rates ≥2.5 mm/year (n=13), 30% for ≥5 mm/year (n=10), and 60% for ≥10 mm/year (n=5).CONCLUSIONS: The cumulative incidence of IPMNs in HRIs is higher than previously reported in the general population. Compared to sporadic IPMNs, they have an increased growth rate. PV carriers with IPMNs are suggested to be at a higher malignancy risk. Intensive follow-up should be considered for PV carriers with an IPMN growing ≥2.5 mm/year, and surgical resection for those growing ≥5 mm/year.
AB - BACKGROUND AND AIMS: In high-risk individuals (HRIs), we aimed to assess the cumulative incidence of intraductal papillary mucinous neoplasms (IPMNs) and compare IPMN growth, neoplastic progression rate, and the value of growth as predictor for neoplastic progression to these in sporadic IPMNs.METHODS: We performed annual surveillance of Dutch HRIs, involving carriers of germline pathogenic variants (PV) and PV-negative familial pancreatic cancer (FPC) kindreds. HRIs with IPMNs were compared to Italian individuals without familial risk under surveillance for sporadic IPMNs.RESULTS: 457 HRIs were followed for 48 months (range 2-172); the estimated cumulative IPMN incidence was 46% (95%CI 28-64). In comparison to 442 controls, IPMNs in HRIs were more likely to grow ≥ 2.5 mm/year (31% versus 7%, P<0.001) and to develop worrisome features (32% versus 19%, P=0.010). PV carriers with IPMNs more often displayed neoplastic progression (n=3, 11%; versus n=6, 1%; P=0.011), while FPC kindreds did not (n=0, 0%; P=1.000). The malignancy risk in a PV carrier with an IPMN was 23% for growth rates ≥2.5 mm/year (n=13), 30% for ≥5 mm/year (n=10), and 60% for ≥10 mm/year (n=5).CONCLUSIONS: The cumulative incidence of IPMNs in HRIs is higher than previously reported in the general population. Compared to sporadic IPMNs, they have an increased growth rate. PV carriers with IPMNs are suggested to be at a higher malignancy risk. Intensive follow-up should be considered for PV carriers with an IPMN growing ≥2.5 mm/year, and surgical resection for those growing ≥5 mm/year.
UR - http://www.scopus.com/inward/record.url?scp=85160077797&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2023.03.035
DO - 10.1016/j.cgh.2023.03.035
M3 - Article
C2 - 37031711
SN - 1542-3565
VL - 22
SP - 62-71.e7
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 1
ER -
