Digestive and Interventional Endoscopy Unit, ASST GOM Niguarda, Milan, ItalyItaly
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Although worrisome features represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high risk of malignancy. Pancreatic resection for worrisome imaging features often demonstrates pathology consistent with low-grade dysplasia. Worrisome features should be considered as indicators of mostly low-grade dysplasia. High-risk stigmata are more consistent for diagnosis of malignant lesions.
Keywords: Worrisome features; High-risk stigmata; Intraductal papillary mucinous neoplasm (IPMN); Pancreatic neoplasm; Pancreatic high-grade dysplasia; Pancreatic low-grade dysplasia; Worrisome features; High-risk stigmata; Intraductal papillary mucinous neoplasm (IPMN); Pancreatic neoplasm; Pancreatic high-grade dysplasia; Pancreatic low-grade dysplasia
PANCREAS PUBLISHERS ISSN 2471-142X Open Journal Lorenzo Dioscoridi, MD, PhD* Digestive and Interventional Endoscopy Unit, ASST GOM Niguarda, Milan, Italy *Corresponding author Lorenzo Dioscoridi, MD, PhD Digestive and Interventional Endoscopy Unit, ASST GOM Niguarda, Milan, Italy; E-mail: dioscoridi.lorenzo@virgilio.it Article information Received: October 20th, 2021; Revised: November 24th, 2021; Accepted: November 25th, 2021; Published: January 3rd, 2022 Cite this article Dioscoridi L. Worrisome features for intraductal papillary mucinous neoplasm: Should we be worried? Pancreas Open J. 2022; 5(1): e1-e2. doi: 10.17140/POJ-5-e013 Worrisome Features for Intraductal Papillary Mucinous Neoplasm: Should We be Worried?
Editorial | Volume 5 | Number 1| e1 Editorial Copyright 2022 by Dioscoridi L. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc P ancreatic cystic neoplasms include different types of cysts with various biological behavior. The most prevalent are intraductal papillary mucinous neoplasm (IPMN). The majority of IPMN is located in the head of the pancreas. A single cystic mass as well as segmental involvement or involvement of the entire pancreatic duct can be present.
Management of IPMN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multi- disciplinary teams.
Worrisome features are indicated and described during imaging study of IPMN.
These features, according to 2017 Fukuoka Consensus Guidelines are cyst size ≥3 cm, thickened or enhancing cyst walls, main duct size 5-9 mm, non-enhancing mural nodules, an abrupt change in pancreatic duct caliber with distal pancreatic atrophy, pancreatitis, and lymphadenopathy.1 Although these data represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high-risk of malignancy.
Izumo et al 2 showed that an enhancing mural nodule ≥5 mm, pancreatitis, and thickened/enhancing cyst walls were in- dependent predictive factors for high-grade dysplasia. However, none of worrisome features were pointed out.
Li et al 3 described a good correlation for prediction of high-grade dysplasia in presence of high-risk stigmata.
Furthermore, pancreatic resection for worrisome imag- ing features often demonstrates pathology consistent with low- grade dysplasia.
A recently published multi-institutional study on 324 pa- tients by Wilson et al 4 found that 44% of specimens resected ac- cording to current guidelines had only low-grade dysplasia.
Sugimoto et al 5 confirmed in a single-center, retrospec- tive analysis, that main pancreatic duct diameter of 7.2 mm (one of the high-risk stigmata) was identified as an optimal cutoff for a prognostic factor for malignant disease in IPMN (Table 1).
Shimizu et al6 developed a nomogram to attempt to pre- dict the probability of the presence of carcinoma in patients with IPMNs. Gender, type of lesion (MD-IPMN vs . BD-IPMN), size of mural nodules and pancreatic fluid cytology were all assigned ABSTRACT Although worrisome features represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high risk of malignancy. Pancreatic resection for worrisome imaging features often demonstrates pathology consistent with low-grade dysplasia. Worrisome features should be considered as indicators of mostly low-grade dysplasia. High-risk stigmata are more consistent for diagnosis of malignant lesions. Keywords Worrisome features; High-risk stigmata; Intraductal papillary mucinous neoplasm (IPMN); Pancreatic neoplasm; Pancreatic high-grade dysplasia; Pancreatic low-grade dysplasia.
Dioscoridi L Pancreas Open J. 2022; 5(1): e1-e2. doi: 10.17140/POJ-5-e013 PUBLISHERS e2 Editorial | Volume 5 | Number 1| points: none of them is classified as worrisome feature.
On the base of the recent literature, we can start to con- sider “worrisome features” as indicators of mostly low-grade dys- plasia and we should not based strict follow-up and/or indications to surgery on them.