IPMNs of the Pancreas: More Epidemiologically Than Clinically Relevant
Menée aux Etats-Unis auprès de 2 114 patients âgés d'au moins 50 ans (durée médiane de suivi : 12 ans), cette étude analyse le risque de cancer du pancréas associé à la présence de tumeurs intra-canalaires papillaires et mucineuses (TIPMP)
The history of intraductal papillary mucinous neoplasms (IPMNs) dates to the early 1980s, when small reports from Japan described rare cystic, mucin-producing tumors of the pancreas. It was only after many years that they were identified as IPMNs, with the specific clinicopathological features that characterize these lesions, allowing them to be distinguished from other pancreatic neoplasms. IPMNs can exhibit different degrees of dysplasia, with the potential to evolve over time from low-grade dysplasia to invasive carcinoma. As a consequence, clinicians considered IPMNs as providing the unique opportunity to make an early treatment of a lethal cancer, such as pancreatic ductal adenocarcinoma. With the advance of knowledge, the situation has become even more complex. It became clear that the risk of malignant transformation was relevant for IPMNs that involved the main pancreatic duct (main-duct or mixed IPMNs) while IPMNs arising from branch ducts (BD-IPMNs) were largely benign. Consequently, while at the beginning of this story all IPMNs underwent resection, nonoperative management was then considered for an increasing number of BD-IPMNs. These observations were subsequently incorporated into guidelines that identified worrisome features (WFs) and high-risk stigmata (HRS) as different categories of risk for malignant neoplasms, recommending active surveillance for BD-IPMNs lacking WFs and HRS. This approach proved to be safe, with few patients with low-risk IPMNs who developed pancreatic malignant neoplasms during surveillance.
JAMA Network Open , éditorial en libre accès, 2022