The goal of surveillance for pancreatic neoplasms, such as branch-duct intraductal papillary mucinous neoplasms (BD IPMNs), is to resect high-grade dysplasia (HGD) before invasive cancer develops. Because most patients with BD IPMN will not develop invasive cancer, patient selection is paramount. Clinical- and imaging-based guidelines seek to identify patients for whom surveillance is safe and those with HGD/invasive cancer for whom surgery is recommended.1 However, the low specificity of guidelines leads to unnecessary surgery.2-4 The presence of mural nodules of at least 5 mm is the best indicator of HGD/invasive cancer, but they are difficult to identify because cross-sectional imaging section thickness borders that threshold.5 Contrast-enhanced endoscopic ultrasonography is more sensitive, but it is operator dependent and unavailable at most centers.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Conroy PC, Nakakura E. Evidence-Based Guidelines for Branch-Duct Intraductal Papillary Mucinous Neoplasm Management: Still a Lot of Room to Grow. JAMA Surg. 2021;156(7):661–662. doi:10.1001/jamasurg.2021.1814
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.