Do all presumed BD-IPMNs require lifelong surveillance? Clinical outcomes and implications of guidelines-based discontinuation.

[BACKGROUND] Management of presumed branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WF) or high-risk stigmata (HRS) remains controversial, particularly regarding the duration of surveillance.

[METHODS] We conducted a retrospective single-center study including patients with presumed BD-IPMNs without WF or HRS at diagnosis, followed between 2014 and 2023. Clinical, radiological, and pathological data were collected. Outcomes included malignant progression, surgery, and mortality. Subgroup analyses assessed patients with ≥5years of follow-up, potentially meeting discontinuation criteria.

[RESULTS] 413 patients met inclusion criteria. Median age at diagnosis was 65 years; 64 % were women. Median cyst size was 10 mm, and median follow-up 36 months. WF developed in 20 % of patients and HRS in 0.7 %. Four patients (0.26/100 person-years) experienced malignant progression, all within 30 months from diagnosis; two underwent surgery, revealing adenocarcinoma in both. In 108 patients followed ≥5 years, 89 remained stable. None developed cancer, required surgery, or died from BD-IPMN. Seven developed WF after 5 years. Depending on criteria, 49 % according to Marchegiani and 63 % according to Kyoto would qualify for discontinuation of surveillance.

[CONCLUSIONS] In real-world practice, malignant progression of presumed BD-IPMNs without WF/HRS is rare and tends to occur early. After 5 years of stability, surveillance discontinuation may be safe in selected subgroups, although prospective validation is needed.