Management of Intraductal Papillary Mucinous Neoplasms with Documented Growth

Introduction to IPMN Management

The American Gastroenterological Association recommends that a growth rate of >5mm/year is associated with a 20-fold higher risk of malignant progression, and represents a worrisome feature requiring closer monitoring 1
The International Association of Pancreatology states that size and growth over time are important criteria in pre-operative management of IPMNs 3, 4, 5

The European Society of Gastrointestinal Endoscopy recommends obtaining MRI with MRCP as the preferred modality to accurately reassess size and evaluate for new worrisome features, although CT can be used if MRI is contraindicated 2
The American College of Radiology suggests that document precise measurements to confirm growth trajectory and rule out measurement variability 3, 4

The National Comprehensive Cancer Network recommends evaluating for high-risk stigmata that mandate surgical consideration, including enhancing solid component or mural nodules ≥5mm, main pancreatic duct diameter ≥10mm, and MPD dilatation between 5-9.9mm 1, 2
The American Society of Clinical Oncology states that serum CA 19-9 level (>37 U/mL) is an independent predictor of malignancy in IPMN 1, 2

The Society of Surgical Oncology recommends referring immediately for surgical consultation in patients fit for surgery if high-risk stigmata are present 1, 2
The American Hepato-Pancreato-Biliary Association suggests obtaining EUS with possible FNA for tissue sampling and detailed evaluation of mural nodules if worrisome features are present, including documented growth 2
The European Society of Medical Oncology recommends increasing surveillance frequency to every 3-6 months if worrisome features are present, and maintaining surgical consultation readiness 2

The International Association of Pancreatology recommends continuing surveillance every 3-6 months given the documented growth rate, and not returning to standard 6-12 month intervals until stability is confirmed over at least 2 years 2
The American Gastroenterological Association states that lifelong follow-up is required as long as the patient remains fit for surgery, as malignancy risk increases over time 1, 2