Surveillance of branch-duct IPMN: Methods and frequency

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common premalignant cystic lesions of the pancreas. Most are incidentally discovered. The prevalence of malignancy at the time of initial identification of BD-IPMNs is very low and they harbor little threat of imminent malignant transformation. Therefore, despite their premalignant nature, immediate surgical resection for all BD-IPMNs is not recommended as the morbidity and mortality of surgery far outweigh the likely benefit of cancer prevention. The possibility of missing an opportunity to surgically cure early cancer, however, is a challenge given our limited understanding of the natural history along with suboptimal diagnostic tools. Consensus criteria for surveillance of BD-IPMNs and indications for surgery have been proposed in 2006 (a.k.a. Sendai criteria) and recently revised in 2012 (a.k.a. Fukuoka criteria). While the evidence to support current recommendations is limited, the trend of available data continues to support deliberate observation for most BD-IPMNs without high-risk stigmata or worrisome features of malignancy. Newer diagnostic tools with better accuracy for diagnosing BD-IPMNs and their dysplasia status are needed to improve clinical management.