Langenbeck's Archives of Surgery

, Volume 403, Issue 2, pp 151–194 | Cite as

Can we better predict the biologic behavior of incidental IPMN? A comprehensive analysis of molecular diagnostics and biomarkers in intraductal papillary mucinous neoplasms of the pancreas

  • Kiara A. Tulla
  • Ajay V. Maker



Predicting the biologic behavior of intraductal papillary mucinous neoplasm (IPMN) remains challenging. Current guidelines utilize patient symptoms and imaging characteristics to determine appropriate surgical candidates. However, the majority of resected cysts remain low-risk lesions, many of which may be feasible to have under surveillance. We herein characterize the most promising and up-to-date molecular diagnostics in order to identify optimal components of a molecular signature to distinguish levels of IPMN dysplasia.


A comprehensive systematic review of pertinent literature, including our own experience, was conducted based on the PRISMA guidelines.


Molecular diagnostics in IPMN patient tissue, duodenal secretions, cyst fluid, saliva, and serum were evaluated and organized into the following categories: oncogenes, tumor suppressor genes, glycoproteins, markers of the immune response, proteomics, DNA/RNA mutations, and next-generation sequencing/microRNA. Specific targets in each of these categories, and in aggregate, were identified by their ability to both characterize a cyst as an IPMN and determine the level of cyst dysplasia.


Combining molecular signatures with clinical and imaging features in this era of next-generation sequencing and advanced computational analysis will enable enhanced sensitivity and specificity of current models to predict the biologic behavior of IPMN.


Intraductal papillary mucinous neoplasm (IPMN) Pancreatic cyst Molecular diagnosis Biomarkers 



Branch duct


Carbohydrate antigen 19-9


Carcinoembryonic antigen


Computed tomography


Endoscopic ultrasound


Intraductal papillary mucinous neoplasm


Loss of heterozygosity


Mucinous cystic neoplasm




Main pancreatic duct


Next-generation sequencing


Negative predictive value


Pancreatic ductal adenocarcinoma


Positive predictive value


Serous cystadenoma


Solid pseudopapillary neoplasm


Tumor-infiltrating lymphocyte



The authors give thanks to Ms. Helena Vonville for the spreadsheets to guide, organize, and execute the systematic review.

Funding information

Dr. Maker is supported by NIH/NCI K08CA190855.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

423_2017_1644_MOESM1_ESM.docx (33 kb)
ESM 1 (DOCX 32 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Microbiology and ImmunologyUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Creticos Cancer Center at AIMMCChicagoUSA

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