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Rapid growth rates of pancreatic cyst BD-IPMNs can predict malignancy

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WASHINGTON — If a branch duct-intraductal papillary mucinous neoplasm grows at a rate of 5 mm or more annually, doubles in size, or grows 10 mm or more overall, it should be considered a “worrisome feature” possibly predicting transformation into a malignancy, according to study findings.

Based on guidelines, most branch duct-intraductal papillary mucinous neoplasm (BD-IPMNs)  are recommended for surveillance imaging, however growth rates that should prompt concern had not previously been identified, according to study background.

“The predictors that we have that are based on cyst morphology are limited and we could use better predictors of malignancy that aren’t based on cyst morphology,” Wilson Kwong, MD, a gastroenterologist at the University of San Diego School of Medicine, said during his presentation. “Cyst size is the result of cyst growth over time, so maybe looking at branch duct human growth rates may be provide an earlier and perhaps more accurate predictor of malignancy.”

Kwong and colleagues aimed to determine whether BD-IPMN growth rates can be predictive of an increased risk of malignancy and to also define what growth rates should be considered as concerning. They conducted a retrospective study of suspected BD-IPMN patients who were undergoing surveillance imaging at 4 southern California endoscopic ultrasound (EUS) referral centers. All patients underwent EUS followed by surveillance imaging.

A total cohort of 284 patients without “worrisome features” or high-risk stigmata were followed for a median of 56 months and had a median of 4 imaging studies.

From the cohort, 3.2% of the patients developed malignant BD-IPMN. The malignant BD-IPMN grew at a faster rate (18.6 mm per year) compared to benign BD-IPMN (0.8 mm per year; P = .05).

BD-IPMN growth rate between 2 mm and 5 mm annually was associated with a higher risk of malignancy (HR = 11.4; 95% CI, 2.2-58.6) when compared with those growth rates that were less than 2 mm per year (P = .004). When the BD-IPMN growth rate was greater than 5 mm per year, the HR was 19.5 (95% CI, 2.4-157.8).

The BD-IPMN growth rate of 2 mm annually had a sensitivity of 78%, a specificity of 90% and an accuracy of 88% to identify a malignancy.

Total growth of a BD-IPMN was associated with a higher risk of malignancy (P = .003) and all malignant IPMNs grew at least 10 mm prior to cancer diagnosis.

“As we have new guidelines that are kind of backing off on how we survey these patients, perhaps there’s a subset that we can identify that maybe we shouldn’t back off so quickly,” Kwong said. “Those with a growth rate of more than 5 mm in a year and those with an overall growth rate of more than 10 mm each had a 36% rate of malignancy and those that doubled in size were malignant 50% of the time, so you may want to keep a closer eye on these.”– by Anthony SanFilippo

For more information: Kwong, W, et al. Abstract 45. Presented at: Digestive Disease Week; May 15-19, 2015; Washington.

Disclosure: Kwong reported no relevant financial disclosures. See the faculty disclosure index on the DDW website for a full list of disclosures.