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Demographic Features and Natural History of Intermediate-Risk Multifocal Versus Unifocal Intraductal Papillary Mucinous Neoplasms

Rosenblatt, Russell MD*; Dorfman, Valerie BA; Epelboym, Irene MD; Poneros, John M. MD§; Sethi, Amrita MD§; Lightdale, Charles MD§; Woo, Yanghee MD; Gress, Frank G. MD§; Allendorf, John D. MD; Schrope, Beth A. MD; Chabot, John A. MD; Gonda, Tamas A. MD§

doi: 10.1097/MPA.0000000000000264
Original Articles

Objectives This study compares the progression of multifocal (MF) intraductal papillary mucinous neoplasms (IPMNs) to unifocal (UF) lesions.

Methods We performed a retrospective review of demographics, risk factors, and cyst characteristics of a prospectively maintained database of 999 patients with pancreatic cysts. Patients included had IPMN under surveillance for 12 months or more. Those with high-risk stigmata were excluded. Cyst size progression and development of worrisome features were compared between MF and UF cohorts. We evaluated whether the dominant cyst in MF-IPMN had more significant growth than did the other cysts.

Results Seventy-seven patients with MF-IPMN and 54 patients with UF-IPMN, with mean follow-up of 27 and 34 months, met the criteria. There were no significant differences between demographics, risk factors, or initial cyst sizes. Fifty-seven percent of MF dominant cysts and 48% of UF cysts increased in size (P = 0.31). Progression in MF was more likely in the dominant cyst (P < 0.05). There were no significant differences in the development of mural nodules or increase in cyst size to more than 3 cm.

Conclusions Demographics of both cohorts were similar, as was the overall incidence of worrisome features. Because meaningful size progression primarily occurred in the dominant cyst, our findings support surveillance based on the dominant cyst in MF disease.

From the *Department of Medicine, Columbia University Medical Center, New York; †Albert Einstein College of Medicine, Bronx; ‡Pancreas Center, Department of Surgery, Columbia University Medical Center; and §Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York; and ∥Department of Surgery, Winthrop University Hospital, Mineola, NY.

Received for publication April 18, 2014; accepted August 14, 2014.

Reprints: Tamas A. Gonda, MD, Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032 (e-mail:

R.R. and V.D. contributed equally to the work.

Author Contributions: R.R.: study concept and design, acquisition of data, drafting of the manuscript. V.D.: acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis. I.E.: statistical analysis. J.M.P.: study concept and design. A.S.: study concept and design. C.L.: study concept and design. Y.W.: study concept and design. F.G.G.: study concept and design. J.D.A.: study concept and design. B.A.S.: study concept and design. J.A.C.: study concept and design. T.A.G.: study concept and design, critical revision of the manuscript for important intellectual content, study supervision.

V.D. was supported by The Office of Medical Student Research at Albert Einstein College of Medicine.

The authors declare no conflict of interest.

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