Natural History of Branch Duct Intraductal Papillary Mucinous Neoplasm With Mural Nodules A Japan Pancreas Society Multicenter Study

作者：Kobayashi Go^*; Fujita Naotaka; Maguchi Hiroyuki; Tanno Satoshi; Mizuno Nobumasa; Hanada Keiji; Hatori Takashi; Sadakari Yoshihiko; Yamaguchi Taketo; Tobita Kousuke; Doi Ryuichiro; Yanagisawa Akio; Tanaka Masao

来源：Pancreas, 2014, 43(4): 532-538.

DOI：10.1097/MPA.0000000000000080

• intraductal papillary mucinous neoplasm
• BD-IPMN - branch duct intraductal papillary mucinous neoplasm
• endoscopic ultrasonography
• PDAC - pancreatic ductal adenocarcinoma
• MPD - main pancreatic duct
• pancreatic ductal adenocarcinoma
• ERCP - endoscopic retrograde cholangiopancreatography
• follow-up
• CT - computed tomography
• US - ultrasonography
• natural history
• EUS - endoscopic ultrasonography
• MN - mural nodule
• MRCP - magnetic resonance cholangiopancreatography

Objective
This study aimed to elucidate the natural history of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with mural nodules (MNs) in branch duct IPMN (BD-IPMN).
Methods
Among the 402 registered patients with BD-IPMN on long-term follow-up at 10 institutions in Japan, 53 patients with MNs of less than 10 mm in height detected by endosonography were included in this study. The morphological changes of the BD-IPMN in these patients and histologic findings of the resected specimen were investigated.
Results
The median height of the MNs at the initial diagnosis was 3 mm (range, 1-8 mm), and 12 (23%) of the 53 patients showed an increase in the height of the MNs during follow-up (mean duration, 42 months). Six patients underwent surgery because of an increase in the height of MNs, yielding high-grade dysplasia in 1 patient and low-grade dysplasia in 5 patients. No patients developed invasive carcinoma derived from IPMN, and distinct pancreatic ductal adenocarcinoma developed in 1 (2%) patient. The incidence of the development of malignancy in BD-IPMNs, including distinct pancreatic ductal adenocarcinoma, was similar to that of those without MNs.
Conclusions
In patients who have BD-IPMN with MNs of less than 10 mm in height, observation instead of immediate resection is considered to be possible.

• 出版日期2014-5