[Skip to Navigation]
Sign In
Views 750
Citations 0
Invited Commentary
May 19, 2021

Evidence-Based Guidelines for Branch-Duct Intraductal Papillary Mucinous Neoplasm Management: Still a Lot of Room to Grow

Author Affiliations
  • 1Division of Surgical Oncology, Section of Hepatopancreaticobiliary Surgery, Department of Surgery, University of California, San Francisco (UCSF)
  • 2UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
JAMA Surg. 2021;156(7):661-662. doi:10.1001/jamasurg.2021.1814

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.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

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.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×