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

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

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.

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Abbreviations

AGA:

American Gastroenterological Association

BD-IPMN:

branch-duct intraductal papillary mucinous neoplasm

ERCP:

endoscopic retrograde cholangiopancreatography

EUS:

endoscopic ultrasonography

EUS-FNA:

endoscopic ultrasound-guided fine needle aspiration

HR:

hazard ratio

HRS:

high risk stigmata

ICG:

International Consensus Guidelines 2012 for the Management of IPMN and MCN of the Pancreas

IPMNs:

intraductal papillary mucinous neoplasms

IPMT:

intraductal papillary mucinous tumour

IQR:

interquartile range

MDCT:

multidetector computed tomography

MD-IPMN:

main-duct intraductal papillary mucinous neoplasm

MPD:

main pancreatic duct

MRCP:

magnetic resonance cholangiopancreatography

PC:

pancreatic cancer

SCN:

serous cystic neoplasm

SHR:

subdistribution hazard ratio

SPN:

solid-pseudopapillary neoplasm

WF:

worrisome feature

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Acknowledgements

We thank Ms. Hisae Kawashiro for data editing.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan

    Koh Imbe, Naoyoshi Nagata, Yuya Hisada, Yusuke Takasaki, Katsunori Sekine, Saori Mishima, Akihito Kawazoe, Mikio Yanase & Junichi Akiyama

  2. Department of Gastrointestinal Oncology, National Cancer Center East Hospital, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Saori Mishima & Akihito Kawazoe

  3. Departments of Diagnostic Radiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan

    Tsuyoshi Tajima

  4. Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan

    Takuro Shimbo

  5. Department of Internal Medicine & Gastrointestinal Endoscopy, Faculty of Medicine, Saga University, 1 Honjo-machi, 840-8502, Saga, Japan

    Kazuma Fujimoto

  6. Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 272-8516, Chiba, Japan

    Naomi Uemura

Authors
  1. Koh Imbe
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  2. Naoyoshi Nagata
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  3. Yuya Hisada
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  4. Yusuke Takasaki
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  5. Katsunori Sekine
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  6. Saori Mishima
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  7. Akihito Kawazoe
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  8. Tsuyoshi Tajima
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  9. Takuro Shimbo
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  10. Mikio Yanase
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  11. Junichi Akiyama
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  12. Kazuma Fujimoto
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  13. Naomi Uemura
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Corresponding author

Correspondence to Naoyoshi Nagata.

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Guarantor

The scientific guarantor of this publication is Dr. Naoyoshi Nagata.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study received funding through the Grant from the National Center for Global Health and Medicine (26A-201, 29-2001 and 29-1025) and Pancreas Research Foundation of Japan.

Statistics and biometry

Dr. Takuro Shimbo has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Our cohort was previously reported in Radiology. 2015:150131. In a previous study, we reported on the natural history of MD-IPMN and BD-IPMN according to the Fukuoka Consensus Guidelines. However, this present study includes 123 patients with IPMNs newly added to our previous database, and we have revised the follow-up period and outcomes accordingly. We have used the current data in the database to evaluate high-risk imaging features, as defined in the AGA guidelines, and validated the AGA follow-up strategy for low-risk BD-IPMNs.

Methodology

• retrospective

• observational

• performed at one institution

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Cite this article

Imbe, K., Nagata, N., Hisada, Y. et al. Validation of the American Gastroenterological Association guidelines on management of intraductal papillary mucinous neoplasms: more than 5 years of follow-up. Eur Radiol 28, 170–178 (2018). https://doi.org/10.1007/s00330-017-4966-x

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  • DOI: https://doi.org/10.1007/s00330-017-4966-x

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