Multidisciplinary Approach to Diagnosis and Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Intraductal papillary mucinous neoplasms have gained recognition in recent years as premalignant precursors to pancreatic cancer that enable early detection and often are found incidentally at imaging. Accurate diagnosis and optimal, finely tuned management of these lesions are important and require collaboration across various disciplines, including radiology, endoscopy, surgery, and pathology. Several imaging modalities can visualize these lesions adequately, each with specific advantages and disadvantages. Multidetector computed tomography and magnetic resonance cholangiopancreatography are generally the first-line imaging modalities; endoscopic imaging such as endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are beneficial when the former 2 modalities are equivocal. Surgical candidates generally include patients with main duct lesions or branch duct lesions greater than 3 cm or any possessing a solid component. A management algorithm indicating when surgery should be pursued is proposed. For nonsurgical and postsurgical patients, follow-up management is important to monitor growth and recurrence, and risks from repeated radiation exposure should be taken into account. Furthermore, issues of multifocality and increased predisposition of the pancreas to ductal adenocarcinoma must be addressed at follow-up evaluation. A follow-up management algorithm also is proposed in this review.

Abbreviations used in this paper: CT, computed tomography, ERCP, endoscopic retrograde cholangiopancreatography, EUS, endoscopic ultrasound, IPMN, intraductal papillary mucinous neoplasm, MDCT, multidetector computed tomography, MRCP, magnetic resonance cholangiopancreatography, PET, positron emission tomography, S-MRCP, secretin-enhanced magnetic resonance cholangiopancreatography, 3D, 3-dimensional, 2D, 2-dimensional