Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience

Abdul El Chafic, Ihab I. El Hajj, John DeWitt, Christian M. Schmidt, Ali Siddiqui, Stuart Sherman, Ashish Aggarwal, Mohammad Al-Haddad

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign. Aims: To describe cyst size changes over time in BD-IPMNs, and determine whether cyst growth rate is associated with increased risk of malignancy. Methods: This is a retrospective study performed at two high volume tertiary centers. Mean cyst size at baseline (MCSB) and mean growth rate percentage (MGRP) were calculated. Rapid cyst growth was defined as MGRP ≥30%/year. Patient and cyst related characteristics were studied. Results: 160 patients were followed for a median of 27.4 (12–114.5) months. MCSB was 15.1 ± 8.0 mm. During follow-up, 73 (45.6%) showed any cyst size increase, of which 15 cysts (9.4%) exhibited MGRP ≥30%/year. Rapid cyst growth was not associated with patient or cyst characteristics. Cyst fluid molecular analysis from 101 cysts showed KRAS mutation in 26. Compared to KRAS-negative cysts, neither MCSB (16.0 mm vs. 17.7 mm; p = 0.3) nor MGRP (3.9%/year vs. 5.8%/year; p = 0.7) was significantly different. Eighteen patients underwent surgery; 15 (83%) had LGD, and 3 had advanced neoplasia. Two cysts with LGD and one cyst with advanced neoplasia had MGRP ≥30%/year. Conclusion: Increase in BD-IPMNs size was not associated with the known high risk patient or cyst-related characteristics. Rapid growth of BD-IPMNs was not associated with advanced neoplasia on surgical pathology.

Original languageEnglish (US)
Pages (from-to)961-968
Number of pages8
JournalDigestive and Liver Disease
Volume50
Issue number9
DOIs
StatePublished - Sep 2018

Keywords

  • Branch-duct IPMN (BD-IPMN)
  • CT
  • Cyst growth rate
  • Dysplasia
  • Endoscopic ultrasound
  • MRI
  • Molecular analysis
  • Neoplasia

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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