Portuguese Pancreatic Club Perspective on Intraductal Papillary Mucinous Neoplasm Diagnosis, Characterization and Indications for Fine-Needle Aspiration/Biopsy, Advanced Endoscopic Ultrasound Imaging Techniques and Role of Pancreatoscopy.

Background: The majority of patients with intraductal papillary mucinous neoplasms (IPMNs) are asymptomatic and diagnosis is incidental when imaging studies are requested due to unrelated indications. Summary: Although they are usually harmless findings, they have potential for malignant transformation. In this review, Portuguese Pancreatic Club summarizes the most recent recommendations regarding diagnosis, characterization, use of advanced endoscopic ultrasound (EUS) modalities, general management of IPMNs and role of pancreatoscopy. Key Messages: Contrast-enhanced magnetic resonance imaging/cholangiopancreatography (MRI) is the preferred imaging modality for the characterization of IPMNs. EUS should be considered in the evaluation of cysts of uncertain significance, in assessing the malignant risk of mucinous lesions, and when MRI is insufficient to define the clinical approach. Fine-needle aspiration with cytological analysis, measurement of biomarkers, and molecular studies in the cyst fluid should only be performed when its results might modify further management. Contrast-enhanced endoscopic ultrasonography, needle-based confocal endomicroscopy and EUS-guided through-the-needle biopsy are promising complementary techniques that may increase diagnostic accuracy. Peroral pancreatoscopy is being increasingly used for main-duct evaluation in patients with suspected or confirmed IPMNs. Many of these techniques are still confined to tertiary referral centers, and associated with steep learning curves and interobserver discrepancy.