SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS
Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort. SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (2 c...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2025-01, p.101959, Article 101959 |
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| creator | Wehrle, Chase J Walsh, R Matthew Kumar, Pranav Perlmutter, Breanna Chang, Jenny H Gross, Abby Naples, Rob Stackhouse, Kathryn A Naffouje, Samer Joyce, Daniel Augustin, Toms Simon, Robert |
| description | Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort.
SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.
One-thousand patients were included, 291 (29.1%) with SB-IPMN1cm (p=0.090).
CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p |
| doi_str_mv | 10.1016/j.gassur.2025.101959 |
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SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (<1cm) lesions. Data are absent regarding the risk of progression in sub-centimeter cysts.
A prospectively maintained database was queried for SB-IPMNs undergoing non-operative surveillance with >2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.
One-thousand patients were included, 291 (29.1%) with SB-IPMN<1cm. Median follow-up from diagnosis was 7.1 years (IQR 3.2-10.4 years) in sub-centimeter cysts vs. 6.4 years (IQR 2.8-10.0 years) in those >1cm (p=0.090).
CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p<0.001). Cysts that progressed did so at similar time intervals (Median=3.7 vs. 3.3 years, p=0.707).
Sub-centimeter cysts developed both IC (1.4% vs 1.8%, log-rank p=0.608), and high-risk pathology (HGD/IC) at a similar rate ( p=0.198) to larger cysts.
Cysts that were initially stable for 5 years of surveillance (n=547) developed high-risk pathology in 4.7% (n=25). This was not different by initial cyst size (log-rank p=0.116).
Spline curves demonstrate consistently low risk of HGD/IC across increasing cyst size despite a higher rate of CR-progression. CR-progression criteria best discriminated high-risk patholgogy in sub-centimeter cysts. Rate of size growth did not correlate with high-risk pathology (HR=1.14, 95%CI 0.88-1.50).
Sub-centimeter SB-IPMNs develop malignant potential as frequently as their larger counterparts and do so at similar time courses. Often incidental, sub-centimeter presumed SB-IPMNs are diagnosed at arbitrary points in their disease course, and require similar surveillance duration to their larger counterparts., Rate of growth is not predictive of high-risk pathology. t These cysts do not develop CR-progression as frequently, but such features better discriminate high risk pathology in sub centimeter cysts, making development of such features more concerning when they occur.</description><identifier>ISSN: 1091-255X</identifier><identifier>ISSN: 1873-4626</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1016/j.gassur.2025.101959</identifier><identifier>PMID: 39793956</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>cyst surveillance ; intraductal papillary mucinous neoplasm ; pancreatic cancer ; pancreatic cyst</subject><ispartof>Journal of gastrointestinal surgery, 2025-01, p.101959, Article 101959</ispartof><rights>2025</rights><rights>Copyright © 2025. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1566-d03a660414b4e9b3cb5880b491af3f1f0432a63f16699951c00c711801c913143</cites><orcidid>0000-0002-9275-4744</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39793956$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wehrle, Chase J</creatorcontrib><creatorcontrib>Walsh, R Matthew</creatorcontrib><creatorcontrib>Kumar, Pranav</creatorcontrib><creatorcontrib>Perlmutter, Breanna</creatorcontrib><creatorcontrib>Chang, Jenny H</creatorcontrib><creatorcontrib>Gross, Abby</creatorcontrib><creatorcontrib>Naples, Rob</creatorcontrib><creatorcontrib>Stackhouse, Kathryn A</creatorcontrib><creatorcontrib>Naffouje, Samer</creatorcontrib><creatorcontrib>Joyce, Daniel</creatorcontrib><creatorcontrib>Augustin, Toms</creatorcontrib><creatorcontrib>Simon, Robert</creatorcontrib><title>SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><description>Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort.
SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (<1cm) lesions. Data are absent regarding the risk of progression in sub-centimeter cysts.
A prospectively maintained database was queried for SB-IPMNs undergoing non-operative surveillance with >2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.
One-thousand patients were included, 291 (29.1%) with SB-IPMN<1cm. Median follow-up from diagnosis was 7.1 years (IQR 3.2-10.4 years) in sub-centimeter cysts vs. 6.4 years (IQR 2.8-10.0 years) in those >1cm (p=0.090).
CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p<0.001). Cysts that progressed did so at similar time intervals (Median=3.7 vs. 3.3 years, p=0.707).
Sub-centimeter cysts developed both IC (1.4% vs 1.8%, log-rank p=0.608), and high-risk pathology (HGD/IC) at a similar rate ( p=0.198) to larger cysts.
Cysts that were initially stable for 5 years of surveillance (n=547) developed high-risk pathology in 4.7% (n=25). This was not different by initial cyst size (log-rank p=0.116).
Spline curves demonstrate consistently low risk of HGD/IC across increasing cyst size despite a higher rate of CR-progression. CR-progression criteria best discriminated high-risk patholgogy in sub-centimeter cysts. Rate of size growth did not correlate with high-risk pathology (HR=1.14, 95%CI 0.88-1.50).
Sub-centimeter SB-IPMNs develop malignant potential as frequently as their larger counterparts and do so at similar time courses. Often incidental, sub-centimeter presumed SB-IPMNs are diagnosed at arbitrary points in their disease course, and require similar surveillance duration to their larger counterparts., Rate of growth is not predictive of high-risk pathology. t These cysts do not develop CR-progression as frequently, but such features better discriminate high risk pathology in sub centimeter cysts, making development of such features more concerning when they occur.</description><subject>cyst surveillance</subject><subject>intraductal papillary mucinous neoplasm</subject><subject>pancreatic cancer</subject><subject>pancreatic cyst</subject><issn>1091-255X</issn><issn>1873-4626</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v2zAMQIVhxdp1-wfDoOMuTkXrI9YOA1xHWYU6dmEl2W6Crcibg6TprGZA_30duOtxJxLkIwk-hD4BmQABcbWd_KpDOPaTmMT8VJJcvkEXkExpxEQs3g45kRDFnP88R-9D2BICUwLJO3RO5VRSycUF-m1W1VrpPE-LTOFyjs3qOspUsdQLtVQVNnqmoutq6N5gfbcozFdcaXN7InWxTo1eKzzTRqVG4bSY4XmZ5-WPaHWHK5WVi4UqZulSl4X5gM7aehf8x5d4iVZztcxuorz8rrM0jxxwIaINobUQhAFrmJcNdQ1PEtIwCXVLW2gJo3EthkwIKSUHR4ibAiQEnAQKjF6iL-Peh_7w5-jDo913wfndrr73h2OwFDhjJJaCDCgbUdcfQuh9ax_6bl_3TxaIPTm2Wzs6tifHdnQ8jH1-uXBs9n7zOvRP6gB8GwE__Pm3870NrvP3zm-63rtHuzl0_7_wDCYFhFI</recordid><startdate>20250108</startdate><enddate>20250108</enddate><creator>Wehrle, Chase J</creator><creator>Walsh, R Matthew</creator><creator>Kumar, Pranav</creator><creator>Perlmutter, Breanna</creator><creator>Chang, Jenny H</creator><creator>Gross, Abby</creator><creator>Naples, Rob</creator><creator>Stackhouse, Kathryn A</creator><creator>Naffouje, Samer</creator><creator>Joyce, Daniel</creator><creator>Augustin, Toms</creator><creator>Simon, Robert</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9275-4744</orcidid></search><sort><creationdate>20250108</creationdate><title>SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS</title><author>Wehrle, Chase J ; Walsh, R Matthew ; Kumar, Pranav ; Perlmutter, Breanna ; Chang, Jenny H ; Gross, Abby ; Naples, Rob ; Stackhouse, Kathryn A ; Naffouje, Samer ; Joyce, Daniel ; Augustin, Toms ; Simon, Robert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1566-d03a660414b4e9b3cb5880b491af3f1f0432a63f16699951c00c711801c913143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>cyst surveillance</topic><topic>intraductal papillary mucinous neoplasm</topic><topic>pancreatic cancer</topic><topic>pancreatic cyst</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wehrle, Chase J</creatorcontrib><creatorcontrib>Walsh, R Matthew</creatorcontrib><creatorcontrib>Kumar, Pranav</creatorcontrib><creatorcontrib>Perlmutter, Breanna</creatorcontrib><creatorcontrib>Chang, Jenny H</creatorcontrib><creatorcontrib>Gross, Abby</creatorcontrib><creatorcontrib>Naples, Rob</creatorcontrib><creatorcontrib>Stackhouse, Kathryn A</creatorcontrib><creatorcontrib>Naffouje, Samer</creatorcontrib><creatorcontrib>Joyce, Daniel</creatorcontrib><creatorcontrib>Augustin, Toms</creatorcontrib><creatorcontrib>Simon, Robert</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wehrle, Chase J</au><au>Walsh, R Matthew</au><au>Kumar, Pranav</au><au>Perlmutter, Breanna</au><au>Chang, Jenny H</au><au>Gross, Abby</au><au>Naples, Rob</au><au>Stackhouse, Kathryn A</au><au>Naffouje, Samer</au><au>Joyce, Daniel</au><au>Augustin, Toms</au><au>Simon, Robert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><addtitle>J Gastrointest Surg</addtitle><date>2025-01-08</date><risdate>2025</risdate><spage>101959</spage><pages>101959-</pages><artnum>101959</artnum><issn>1091-255X</issn><issn>1873-4626</issn><eissn>1873-4626</eissn><abstract>Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort.
SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (<1cm) lesions. Data are absent regarding the risk of progression in sub-centimeter cysts.
A prospectively maintained database was queried for SB-IPMNs undergoing non-operative surveillance with >2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.
One-thousand patients were included, 291 (29.1%) with SB-IPMN<1cm. Median follow-up from diagnosis was 7.1 years (IQR 3.2-10.4 years) in sub-centimeter cysts vs. 6.4 years (IQR 2.8-10.0 years) in those >1cm (p=0.090).
CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p<0.001). Cysts that progressed did so at similar time intervals (Median=3.7 vs. 3.3 years, p=0.707).
Sub-centimeter cysts developed both IC (1.4% vs 1.8%, log-rank p=0.608), and high-risk pathology (HGD/IC) at a similar rate ( p=0.198) to larger cysts.
Cysts that were initially stable for 5 years of surveillance (n=547) developed high-risk pathology in 4.7% (n=25). This was not different by initial cyst size (log-rank p=0.116).
Spline curves demonstrate consistently low risk of HGD/IC across increasing cyst size despite a higher rate of CR-progression. CR-progression criteria best discriminated high-risk patholgogy in sub-centimeter cysts. Rate of size growth did not correlate with high-risk pathology (HR=1.14, 95%CI 0.88-1.50).
Sub-centimeter SB-IPMNs develop malignant potential as frequently as their larger counterparts and do so at similar time courses. Often incidental, sub-centimeter presumed SB-IPMNs are diagnosed at arbitrary points in their disease course, and require similar surveillance duration to their larger counterparts., Rate of growth is not predictive of high-risk pathology. t These cysts do not develop CR-progression as frequently, but such features better discriminate high risk pathology in sub centimeter cysts, making development of such features more concerning when they occur.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>39793956</pmid><doi>10.1016/j.gassur.2025.101959</doi><orcidid>https://orcid.org/0000-0002-9275-4744</orcidid></addata></record> |
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| language | eng |
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| source | Alma/SFX Local Collection |
| subjects | cyst surveillance intraductal papillary mucinous neoplasm pancreatic cancer pancreatic cyst |
| title | SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS |
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