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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.

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