Currently, there is no reliable method of discerning between low-risk and high-risk intraductal papillary mucinous neoplasms (IPMNs). Operative resection is utilized in an effort to resect those lesions with high-grade dysplasia (HGD) prior to the development of invasive disease. The current guidelines recommend resection for IPMN that involve the main pancreatic duct. Resecting lesions with HGD before their progression to invasive disease and the avoidance of resection in those patients with low-grade dysplasia is the optimal clinical scenario. Therefore, the importance of developing preoperative models able to discern HGD in IPMN patients cannot be overstated. Low-risk patients should be managed with nonsurgical treatment options (typically MRI surveillance), while high-risk patients would undergo resection, hopefully prior to the formation of invasive disease. Current research is evolving in multiple directions. First, there is an ongoing effort to identify reliable markers for predicting malignant transformation of IPMN, mainly focusing on genomic and transcriptomic data from blood, tissue, and cystic fluid. Also, multimodal models of combining biomarkers with clinical and radiographic data seem promising for providing robust and accurate answers of risk levels for IPMN patients.
目前，尚无可靠方法能够准确区分低风险与高风险导管内乳头状黏液性肿瘤（IPMN）。手术切除旨在对具有高级别异型增生（HGD）的病变进行干预，以防止其发展为浸润性疾病。现行指南建议对累及主胰管的IPMN实施切除。在病变进展为浸润性疾病前切除具有HGD的病灶，同时避免对低级别异型增生患者进行手术切除，是最理想的临床处理方案。因此，开发能够术前鉴别IPMN患者HGD的预测模型具有极其重要的意义。低风险患者应采取非手术治疗方案（通常为MRI监测），而高风险患者则需接受切除手术，并期望在浸润性疾病形成前完成干预。当前研究正朝着多个方向深入发展：一方面，学界持续致力于寻找能够预测IPMN恶性转化的可靠标志物，研究重点主要集中在血液、组织及囊液的基因组与转录组数据；另一方面，将生物标志物与临床及影像学数据相结合的多模态模型展现出巨大潜力，有望为IPMN患者的风险分层提供更为稳健且精准的评估依据。
An Overview for Clinicians on Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas
肿瘤(癌症)患者之家