Natural History of Branch Duct Intraductal Papillary Mucinous Neoplasm With Mural Nodules

Objective: This study aimed to elucidate the natural history of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with mural nodules (MNs) in branch duct IPMN (BD-IPMN). Methods: Among the 402 registered patients with BD-IPMN on long-term follow-up at 10 institutions in Japan, 53 patients with MNs of less than 10 mm in height detected by endosonography were included in this study. The morphological changes of the BD-IPMN in these patients and histologic findings of the resected specimen were investigated. Results: The median height of the MNs at the initial diagnosis was 3 mm (range, 1Y8 mm), and 12 (23%) of the 53 patients showed an increase in the height of the MNs during follow-up (mean duration, 42 months). Six patients underwent surgery because of an increase in the height of MNs, yielding high-grade dysplasia in 1 patient and low-grade dysplasia in 5 patients. No patients developed invasive carcinoma derived from IPMN, and distinct pancreatic ductal adenocarcinoma developed in 1 (2%) patient. The incidence of the development of malignancy in BDIPMNs, including distinct pancreatic ductal adenocarcinoma, was similar to that of those without MNs. Conclusions: In patients who have BD-IPMN with MNs of less than 10 mm in height, observation instead of immediate resection is considered to be possible.